Testing Requirements for all Professional Provider Types
The list below represents a sampling of scenarios that may be required to certify. It will be acceptable to include multiple scenarios in a single claim.

• BCBSNE Subscriber as patient
• BCBSNE Dependent as patient
• BCBSNE Secondary
• One FEP Primary
• One FEP Secondary
• BCBSNE Primary and > 11 service line (single provider)
• BCBSNE Primary and > 11 service line (multiple providers with same Tax ID on same claim)
• BCBSNE Primary and > 1 ICD-9 diagnostic code at the claim level and > 1 at the line level
• BCBSNE Primary and PWK at the claim level
• BCBSNE Primary and PWK at the service line level
• BCBSNE Primary and HCPC modifiers on > 1 service line
• BCBSNE Primary and Consecutive dates billed as a span for the same CPT-IV/HCPC code using units to identify number of services
• BCBSNE Primary and Multiple single dates of service for the same CPT/HCPC service code
• BCBSNE Primary and Inpatient services
• BCBSNE Primary and Outpatient services
• BCBSNE Primary and Unlisted procedure

Specialty Services
(If you are a specialty provider, you must send one claim that meets requirements below, in addition to the above.)

• BCBSNE Primary and Anesthesia services using ASA coding
• BCBSNE Primary and Surgical Procedure from Anesthesiologist
• BCBSNE Primary and Anesthesia with patient risk
• BCBSNE Primary and OB services (global and/or transferred care)
• BCBSNE Primary and Chiropractic services (accident and non-accident)
• BCBSNE Primary and Home Health supply charges
• BCBSNE Primary and Ambulance charges that include mileage
• BCBSNE Primary and > 1 mental health service (assessment and counseling)
• BCBSNE Primary and Cardiac Rehab
• BCBSNE Primary and Durable Medical Equipment (rental and purchase)
• BCBSNE Primary and > 1 surgery CPT-IV/HCPC code
• BCBSNE Primary and Surgeon charges and assistant MD surgeon charges
• BCBSNE Primary and Surgery with a PA assistant at surgery
• BCBSNE Primary and Ambulatory Surgery Center
• BCBSNE Primary and Freestanding Dialysis Center with > one service date
• BCBSNE Primary and Independent Lab with > 1 service line
• BCBSNE Primary and Psychiatric Daycare with > 1 service date
• BCBSNE Primary and Freestanding Alcohol and Drug Rehab with > 1 service date
• BCBSNE Primary and Chemotherapy (intended and actually performed)
• BCBSNE Primary and Oral Surgery with office anesthesia
• BCBSNE Primary and Physical Therapy, Occupational or Speech Therapy
• BCBSNE Primary and Vision Care including exam and dispensing