Publication Date: 

In October, we shared information about a new case-mix classification model. As a reminder, you should now be filing claims with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) with the Patient Driven Payment Model (PDPM) values instead of RUGS values.

Claims filed with dates of service on or after October 1, 2019, should include:

  • PDPM conforming codes
  • AND the information contained in the authorization for the patient

Claims filed without PDPM coding cannot be processed and will be returned to providers to be corrected.