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Government Programs Claims Handling and Post-adjudication Process Changes, Effective Jan. 1, 2017

Posted September 30, 2016

A number of changes will be implemented as of Jan. 1, 2017, to help improve efficiencies in routing, handling and post-adjudication processes for government programs claims. A preview of the changes and related reminders is included below. Additional information will be published in the coming months. Please watch the Blue Review, as well as the News and Updates section of our Provider website. 

BLUE CROSS MEDICARE ADVANTAGESM

The following changes will apply to claims submitted for Blue Cross Medicare Advantage PPOSM and Blue Cross Medicare Advantage HMOSM members (alpha prefixes XOD, XOJ):

  • New Payer ID (66006) – Beginning Jan. 1, 2017, Payer ID 66006 must be included on electronic claims received for Blue Cross Medicare Advantage PPO and Blue Cross Medicare Advantage HMO members. Blue Cross Medicare Advantage claims received with the commercial Payer ID (00621) will not be accepted.*
  • Electronic Remittance Advice (835 ERA) – Effective Jan. 1, 2017, 835 ERA files will be distributed to the address associated with the billing provider’s Tax ID, rather than being parsed to multiple locations.
  • Paper Claim Mailing Address and Fax – Effective Jan. 1, 2017, the mailing address and fax number for paper claims for non-delegated providers will be:

Blue Cross Medicare Advantage
P.O. Box 3686
Scranton, PA 18505
Fax: (855) 674-9192

  • Payment Cycle – Effective Jan. 1, 2017, Blue Cross Medicare Advantage claim payments will be sent on a weekly basis.
  • Overpayment Recovery – A new overpayment recovery process will be implemented as of Jan. 1, 2017; details are forthcoming.

*If you utilize a practice management/hospital information system or billing service, and/or a clearinghouse other than AvailityTM or Passport/Nebo Systems for electronic claim submission, please contact your vendor to confirm they are using the new Payer ID for the alpha prefixes referenced above, rather than assigning their own unique number. 

BLUE CROSS COMMUNITY OPTIONSSM – MMAI, ICP, FHP and MLTSS

The following changes will apply to claims submitted for Blue Cross Community MMAI (Medicare-Medicaid Plan)SM, Blue Cross Community Integrated Care Plan (ICP)SM, Blue Cross Community Family Health PlanSM (FHP) and Managed Long Term Supports and ServicesSM (MLTSS) members (alpha prefix XOG):

  • 835 ERA – Effective Jan. 1, 2017, 835 ERA files will be distributed to the address associated with the billing provider’s Tax ID, rather than being parsed to multiple locations.
  • Paper Claim Mailing Address and Fax The paper claim mailing address and fax numbers for MMAI, ICP, FHP and MLTSS will be:

Blue Cross Community Options
P.O. Box 4168
Scranton, PA 18505
Fax: MMAI – (855) 674-9193; ICP – (855) 297-7280; FHP – (855) 426-5335; MLTSS – (855) 426-5339.

  • Payment Cycle – Effective Jan. 1, 2017, Blue Cross Community Options claim payments will be sent on a twice-weekly basis.
  • Overpayment Recovery – A new overpayment recovery process will be implemented as of Jan. 1, 2017; details are forthcoming.

There will be no change to the current electronic Payer ID (MCDIL) for Blue Cross Community Options (MMAI, ICP, FHP and MLTSS) claims. However, if you utilize a practice management/hospital information system or billing service, and/or a clearinghouse other than Availity or Passport/Nebo Systems, please contact your vendor to confirm use of the correct Payer ID on electronic claims submitted for MMAI, ICP, FHP and MLTSS members. 

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. Passport/Nebo Systems is an independent third party vendor and is solely responsible for its products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by Availity or Passport/Nebo Systems. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.