Government Programs: Electronic Claim-related Process Improvements and Reminders

Posted August 23, 2018

The notice applies to providers submitting Blue Cross and Blue Shield of Illinois (BCBSIL) government programs claims for services rendered to our Medicare Advantage and Illinois Medicaid members. This includes Blue Cross Medicare Advantage (PPO)SM, Blue Cross Medicare Advantage (HMO)SM, Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members.

Providers submitting electronic government programs claims for our Medicare Advantage and Illinois Medicaid members may have experienced membership validation claim rejections and duplicate claim rejections. The duplicate claim rejections occurred when Professional and Institutional electronic claims (837P and 837I transactions) were resubmitted within 90 days of a previously submitted claim that included the exact data for the same patient and date(s) of service.

Effective Sept. 15, 2018, BCBSIL will implement claim processing changes to eliminate the above-referenced claim rejection issues. With this implementation, some providers may encounter new claim submission edits for Professional and Institutional claims (837P and 837I transactions), which will help improve accuracy and timeliness in processing. Claims with insufficient or invalid data will reject upon claim submission, allowing providers to correct the error(s) and resubmit the claim immediately, thereby avoiding claim processing delays. Additionally, for electronic claims submitted by 5 p.m. (CT), submitters should receive their payer acknowledgement response files on the same day.

These changes will not impact electronic fund transfer (835 EFT) or electronic remittance advice (835 ERA) transactions.

As a reminder, electronic claims that are submitted via the Availity® Provider Portal or Experian Health must be submitted using Payer ID 66006 for Medicare Advantage and Payer ID MCDIL for Illinois Medicaid claims. For claims that are submitted using direct data entry on the Availity Portal, providers should select the drop-down payer option of “Blue Cross Medicare Advantage” for Medicare Advantage claims and “Blue Cross Community Health Plans” for Illinois Medicaid claims.

Providers who are not registered with Availity or Experian Health should contact their clearinghouses to confirm the appropriate Payer IDs to be used when submitting government programs claims, as other clearinghouses may assign their own unique numbers.

Please share this notice with your practice management/hospital information system software vendor, billing service or clearinghouse, if applicable. For additional information on electronic options, refer to the Electronic Commerce page on our Provider website.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. Experian Health 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 provided by third party vendors such as Availity and Experian Health. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.