Facility Claims for Medical Injectables: Site of Care Issues

Highmark Blue Cross Blue Shield of Western New York (BCBSWNY) is seeing an uptick in denied claims — submitted by physicians — for medical injectables at facilities.

If the Site of Care on the authorization doesn’t match the claim, Highmark will reject the claim.

Physician-Requested, Facility-Dispensed

Please ensure when completing the authorization form that a Site of Care IS filled out. This is most important when you are requesting an authorization for medical injectables which will be dispensed in a hospital/facility setting.

If the Site of Care is left blank on the claim, it will default to Physician Office. If that doesn’t match the authorization, the claim will be denied.

For example, if the service is performed at a hospital/facility, but the authorization has Physician Office as the Site of Care, the claim will be denied.

Doublecheck the Site of Care on all claims to ensure it matches the authorization. If the Site of Care on the authorization has changed, providers should file an updated authorization request.

For the correct medical injectable authorization form, go here.