Interim Billing

Submit all interim billings to Blue Cross and Blue Shield of Nebraska, even if the charges are paid in full by another payer. The claims are posted to the patient’s claim history and may be used to credit out-of-pocket expenses, such as deductible and coinsurance. 

Interim inpatient claims (bill types xx2 and xx3) should not be for time periods less than 30 days and should contain patient status code 30. Billing periods should not overlap. 

Inpatient

Where an appropriate interim inpatient bill is submitted and when a specific inlier/outlier contracted rate has been established for the DRG category for that claim, the first interim claim will be paid based on the contracted rate calculation. Subsequent interim claim(s) reimbursement will be made via the combined calculation of the payment amount(s) made on the previous claims(s), plus any additional amounts due for the current claim based on the resultant DRG category of the billing combination process. The final payment (or refund) on the claim will be based on the regrouping of all previous interim claim data and all previous payments made, subject to the reimbursement amount for the final DRG category. Each interim bill must include all diagnoses, procedures and services from admission to the through date.

Outpatient

Interim billings may be submitted for outpatient services that are expected to occur over a period of time (i.e., physical therapy, cardiac rehabilitation, etc.). Appropriate use of the third digit of the bill type code is essential to proper claim payment.