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Get Carefirst Bcbs Ancillary Claims Filing Guidelines - Examples 2018-2024

) Electronic: On the 837 Professional, use Loop 2310A (claim level) Types of service include, but are not limited to: blood, urine, samples, analysis, etc. Paper: On the CMS 1500 Health Insurance Claim Form, use Field 17 Referring Provider NPI: Electronic: On the 837 Professional, use Loop 2310A, Segment NM109 Paper: On the CMS 1500 Health Insurance Claim Form, use Field 17B Place of Service: Electronic: On the 837 Professional, use Loop 2300, Segment CLM05-1 Paper: On the CMS 1500 Health Ins.

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