CurrentFlorida BluePolicy 22-078

Third Party Billing When a Member is Inpatient (Under Arrangement Services)

Governs billing and reimbursement for non-professional services provided to Florida Blue members by third-party entities while the member is registered as an inpatient; applies to all lines of business including commercial and Medicare Advantage and to multiple facility types.

Policy Summary

PayerFlorida Blue

PolicyThird Party Billing When a Member is Inpatient (Under Arrangement Services)

Policy CodePolicy 22-078

Change TypeNo material changes

Effective DateAug 12, 2012

Next Review Date

Key ActionThird-party providers must submit or bill services performed while the member is inpatient to the admitting facility so charges can be added to the inpatient claim and submitted to Florida Blue.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All-inclusiveInpatient reimbursement

Commercial & MAProducts governed

22-078Identifier

2026-02-12Last revised

Third-party Inpatient Billing Coverage Criteria

Third-party inpatient billing criteria

Services performed by third-party providers while a member is registered as an inpatient are generally not separately billable to Florida Blue and must be billed to the admitting facility for inclusion on the inpatient claim. Specific service applicability by facility type is listed below.

Non-professional services provided by entities other than the admitting facility during inpatient registration are not separately billable to Florida Blue; the facility adds charges to the member's inpatient claim and submits to Florida Blue subject to existing reimbursement methodology.

Exceptions

Federal or State law that indicates third-party payors can be billed for the inpatient service and are liable to make payment to the designated entity.

Service applicability by facility type

Short Term Acute Care — Laboratory: Yes; Radiology/Advanced Imaging: Yes; Ambulance: Yes*.

Policy Summary

PayerFlorida Blue

PolicyThird Party Billing When a Member is Inpatient (Under Arrangement Services)

Policy CodePolicy 22-078

Change TypeNo material changes

Effective DateAug 12, 2012

Next Review Date

SourceLink

On This Page

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Coding and Submission Guidance

General coding guidancemixed

No codes listed

Submission routing — third‑party inpatient charges

Submission routingThird-party provider must submit or bill charges to the admitting facility; the facility adds those charges to the member's inpatient hospital claim and submits the consolidated claim to Florida Blue.

Facility responsibilityThe facility is responsible for including third‑party charges on the inpatient claim and is liable to the third‑party provider for services performed on the facility's behalf.

Reimbursement subject to methodologyCharges added to the inpatient claim are processed subject to Florida Blue's existing inpatient reimbursement methodology.

Exception—federal/state lawIf Federal or State Law permits billing third‑party payors for the inpatient service, that exception applies and the third‑party may be billed directly.

Applicability to provider typesApplies when services are performed by third‑party entities under arrangement with the facility because the facility cannot perform the service or the service is necessary but unavailable at the facility.

Billing Process for Third-Party Inpatient Services

Billing Rule

Billing Process for Third‑Party Inpatient Services

Services performed outside the facility while the member is registered as an inpatient must be submitted or billed to the admitting facility by the third‑party provider; the facility will add those charges to the member's inpatient hospital claim and submit the consolidated claim to Florida Blue. The facility is liable to the third‑party provider for services performed on the hospital's behalf. Exceptions apply only when Federal or State law permits billing the third‑party payor directly and makes that payor liable for payment.

Third‑party provider submits charges to the admitting facility.
Admitting facility adds third‑party charges to the inpatient hospital claim and submits to Florida Blue.
Facility is responsible to make the third‑party provider whole for services performed on its behalf.
Exception: follow Federal or State law if it authorizes direct third‑party payor billing and liability.

Key Definitions

All‑inclusive (definition)

All‑inclusive definitionFlorida Blue's inpatient reimbursement methodology, regardless of participation status, is all‑inclusive; non‑professional services provided by entities other than the admitting facility while the member is registered as an inpatient are not separately billable to Florida Blue.

Scope—facility typesApplies to acute care hospitals, long term acute care hospitals, skilled nursing facilities, psychiatric hospitals/facilities, substance abuse hospitals/facilities, and residential treatment centers/facilities.

Product applicabilityPolicy applies to Florida Blue commercial products and Medicare Advantage products (with Medicare‑specific exceptions noted elsewhere).

Service eligibilityServices covered by this all‑inclusive approach are non‑professional services that third‑party entities are licensed to perform.

Third‑party services — definition

Third‑party services — definitionThird‑party services are non‑professional services provided to a Florida Blue member by an entity other than the admitting facility while the member is registered as an inpatient.

When usedThese services may be performed by a third‑party entity under arrangement with the facility because the facility is unable to perform the service or the service is not available but is necessary to treat the member.

Licensing requirementThe services identified in this policy are services that the third‑party provider type is licensed to perform.

Billing expectationAlthough performed by a third party, charges must be submitted to the admitting facility for inclusion on the inpatient claim to Florida Blue (subject to exceptions under law).