The Institutional and Professional Implementation Guides do not specifically address what format to use when submitting home infusion claims. How will Blue Cross process a home infusion claim submitted as an 837 Institutional claim? How will Blue Cross process a home infusion claim submitted as an 837 Professional claim?

Blue Cross EDI Gateway must accept any ANSI-compliant home infusion claim submitted on either 837I or 837P. However, Blue Cross will reject any 837P home infusion claim during the internal business editing process as “not a contracted service for this form type.” A home infusion provider would have to use the 837I format in order to receive payment under the terms of their contract.

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Blue Cross EDI Gateway must accept any ANSI-compliant home infusion claim submitted on either 837I or 837P.