Reminder: Itemized Bills

April 21, 2022

Itemized bills are required for high dollar pre-payment (HDPR) reviews and should be submitted, when requested, via My Insurance Manager℠ (MIM) using the claims attachment feature. As a reminder, the dollar amount for HDPR reviews was reduced to $100,000.00 on Jan. 1, 2021.

Note: Medical records should not be submitted in lieu of itemized bills. If medical records are needed, a separate request will be sent to include instructions on how to submit. Please refrain from submitting unwarranted medical records.

When submitting itemized bills, be sure they are specific. Each line must have a clear description including doses, names of supplies and so forth. Also, be sure the revenue code and date of service for each line is present.

Example of an acceptable itemized bill:

42 Rev. Co.	43 Description	44 HCPCS/Rate/HPPS Code	45 Serv. Date	46 Serv. Units	47 Total Charges
0250	Dicyclomine 10 MG		010322	1	27.00
0250	Nitroglycerin 0.4 MG		010322	1	28.73
0250	Midazolam 10 MG	J2250	010322	2	29.09
0250	Atorvastatin 40 MG		010322	2	76.93
0272	Catheter Angiographic		010322	1	226.00
0272	Guidewire Vascular 3CM	C1769	010322	1	3597.00
0278	Device Vascular Closure	C1760	010322	1	2563.00

Example of an unacceptable itemized bill:

42 Rev. Co.	43 Description	44 HCPCS/Rate/HPPS Code	45 Serv. Date	46 Serv. Units	47 Total Charges
0250	Pharmacy			336	7780.81
0272	Sterile Supply			8	7680.40
0278	Supply/Implants			2	6358.00

If you have any questions regarding this bulletin, please feel free to contact the provider education team at 803-264-4730 or Provider.Education@bcbssc.com.