Guidelines - 3.6 Approved Sharing of Bills

To be eligible for sharing, providers must submit their billing via 1) 
the Electronic Data Interchange (EDI) on the REDEEM Member Card, 
2) a Center for Medicare and Medicaid Services card (CMS) 1500, 
or 3) a Uniform Billing (UB). Bills submitted by providers must follow 
standard healthcare industry submission and coding guidelines to 
meet sharing consideration.

Many medical providers are willing to submit their bills 
electronically via the Member Card EDI number. However, if you 
manually submit a bill for processing, you must submit the bill 
using the online submission portal in the Member Center. Ask your 
provider for a superbill, which is a common and comprehensive 
healthcare industry billing documentation format. The healthcare 
industry uses multiple terms interchangeably to describe a 
medical bill such as, superbill, itemized statement, patient ledger, 
or account history (not a comprehensive list).

Member submitted bills and documents must include the 
following itemized details:

• Name of patient

• Diagnosis and International Classification of Diseases (ICD-10) 
codes

• Procedure and Current Procedural Terminology (CPT) codes

• Provider’s TAX ID

• Provider’s National Provider Identifier (NPI)

• Provider’s billing address

• Facility service and physical address

• Date of service

• Charged amounts

When submitting a medical bill for processing, you are responsible 
for obtaining all information needed for processing per the 
prompts in the online submission portal.

The services or items in the bills must be eligible for sharing and 
within the scope of licensing and ordered or provided by a:

• Medical Doctor (M.D.)

• Doctor of Osteopathy (D.O.)

• Naturopathic Doctor (N.D.)

• Nurse Practitioner (N.P. or A.P.R.N.)

• Physician Assistant (P.A.)

• Doctor of Podiatric Medicine (D.P.M.)

• Dentist (D.D.S. or D.M.D.)

• Midwife (if certified)

• Ophthalmologist

• Optometrist

• Optician

• Chiropractor

These tests and treatments must occur at a CMS designated site 
of care or one of the following:

• Hospital

• Ambulatory center

• Clinic

• Doctor’s office

• Diagnostic facility (lab or imaging)

• Independent Facilities

• Residential setting (for home births, hospice care, and preapproved home health)

• Skilled Nursing and Rehabilitation Facility

• Telehealth