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Filing BlueCard® Ancillary Claims

Generally, claims should be filed to the local Blue Cross and Blue Shield Plan. However, there are unique circumstances when claims filing directions will differ based on the type of provider and service.

Ancillary providers are Independent Clinical Laboratory, Durable/Home Medical Equipment and Supplies and Specialty Pharmacy providers. The local Blue Plan as defined for ancillary services is as follows:

Independent Clinical Laboratory (Lab)

  • The Plan in whose state* the specimen was drawn.

Durable/Home Medical Equipment and Supplies (DME)

  • The Plan in whose state* the equipment was shipped to or purchased at a retail store.

Specialty Pharmacy

  • The Plan in whose state* the ordering physician is located.

* If you contract with more than one Plan in a state for the same product type (i.e., PPO or Traditional), you may file the claim with either Plan.


Provider TypeHow to file
(required fields)		Where to fileExample

Independent Clinical Laboratory
(any type of non-hospital based laboratory)

Types of Service include, but are not limited to: blood, urine, samples, analysis, etc.

Referring Provider:

  • Field 17B on CMS 1500 Health Insurance Claim Form or
  • Loop 2310A (claim level) on the 837 Professional Electronic

File the claim to the Plan in whose state the specimen was drawn*


* Where the specimen was drawn will be determined by which state the referring provider is located.

Blood is drawn* in lab or office setting located in Texas. 

Blood analysis is done in California. 

File to: Texas.


* Claims for the analysis of a lab must be filed to the Plan in whose state the specimen was drawn.

Durable/Home Medical Equipment and Supplies (D/HME)


Types of Service include, but are not limited to:

hospital beds, oxygen tanks, crutches, etc.

Patient's Address:

  • Field 5 on CMS 1500 Health Insurance Claim Form or
  • Loop 2010CA on the 837 Professional Electronic Submission.

Ordering Provider:

  • Field 17B on CMS 1500 Health Insurance Claim Form or
  • Loop 2420E (line level) on the 837 Professional Electronic Submission.

Place of Service:

  • Field 24B on the CMS 1500 Health Insurance Claim Form or
  • Loop 2300, CLM05-1 on the 837 Professional Electronic Submissions.

Service Facility Location Information:

  • Field 32 on CMS 1500 Health Insurance Form or
  • Loop 2310C (claim level) on the 837 Professional Electronic Submission.

File the claim to the Plan in whose state the equipment was shipped to or purchased in a retail store.
  1. Wheelchair is purchased at a retail store in Texas.
    File to: Texas
  2. Wheelchair is purchased on the internet from an online retail supplier in Ohio and shipped to Texas
    File to: Texas
  3. Wheelchair is purchased at a retail store in Texas and shipped to Arizona.
    File to: Arizona

Specialty Pharmacy

Types of Service:
Non-routine, biological therapeutics ordered by a healthcare professional as a covered medical benefit as defined by the member's Plan's Specialty Pharmacy formulary.

Includes, but are not limited to: injectable, infusion therapies, etc.

Referring Provider:

  • Field 17B on CMS 1500 Health Insurance Claim Form or
  • Loop 2310A (claim level) on the 837 Professional Electronic Submission.

File the claim to the Plan whose state the Ordering Physician is located.

Patient is seen by a physician in Texas who orders a specialty pharmacy injectable for this patient. Patient will receive the injections in Colorado where the member lives for 6 months of the year.

File to: Texas


The ancillary claim filing rules apply regardless of the provider's contracting status with the Blue Plan where the claim is filed.

Providers are encouraged to verify member eligibility and benefits by contacting the phone number on the back of the member ID card or call 800-676-BLUE, prior to providing any ancillary service.

Providers that utilize outside vendors to provide services (e.g., sending blood specimen for special analysis that cannot be done by the lab where the specimen was drawn) should utilize in-network participating ancillary providers to reduce the possibility of additional member liability for covered benefits. A list of in-network participating providers may be obtained by using the Provider Finder®.

Members are financially liable for ancillary services not covered under their benefit plan. It is the provider's responsibility to request payment directly from the member for non-covered services.

If you have any questions about where to file your claim, please contact the BCBSTX Provider Customer Service at 800-451-0287.


Posted 06/2012