Blue Cross Newsletter

September 26, 1994                           BLUE CROSS NEWSLETTER
                                             *********************

TO:         FREESTANDING RURAL HEALTH CLINICS

FROM:       Donna Bartee, Communications Coordinator
            Provider Relations Department

SUBJECT:    OBTAINING PAYMENT FROM BLUE CROSS FOR
            MEDICARE'S DEDUCTIBLE AND COINSURANCE
            *************************************

We're having problems with the way some freestanding rural health
clinics are submitting information in order to obtain payment from
Blue Cross for Medicare's deductible and coinsurance.

We therefore want to take this opportunity to review the correct
procedures with you.

When we were first notified that you were certified by Medicare as
a rural health clinic, we assigned to you A BLUE CROSS PROVIDER
NUMBER THAT IS TO BE USED ONLY FOR PAYING BALANCES REMAINING AFTER
MEDICARE'S PAYMENT.  This Blue Cross provider number is entirely
different than your regular Blue Shield number and the two ARE NOT
INTERCHANGEABLE.

Here's the recap of what we need:

--  Send us a copy of the Medicare remittance advice which clearly
    reflects:
               your name and complete address
               your Medicare provider number
               your BLUE CROSS OF KANSAS (not 'Blue Shield')
                    provider number

--  On the Medicare remittance advice, CIRCLE, BRACKET, OR
    HIGHLIGHT the payment information that needs to be processed
    (limit to one request per page)

--  **IMPORTANT** If you have multiple payments or patients on the
    same page of the remittance advice that need to be processed by
    Blue Cross, you will need to duplicate that page and submit a
    separate copy of EACH CASE that needs handled.

--  Make sure the patient's 'complete' name and Blue Cross of
    Kansas identification number are reflected on the remittance
    advice.

--  For insureds enrolled in a Medicare Exclusion Rider (MER)
    contract, IN ADDITION to the information listed above, you will
    also need to include a copy of the UB-92 claim form that was
    submitted to the Medicare intermediary.

--  **IMPORTANT**  Never send a copy of a HCFA 1500 claim form with
    these requests.  If you need to send a copy of the claim, make
    sure it's the UB-92 that was submitted to the Medicare
    intermediary.

If you indicate the wrong provider number or if you attach a
HCFA 1500 instead of the UB-92, this causes us processing problems
and in turn, eventually, causes you problems too (slow payments,
incorrect payments or no payments).

It's really important that this information be submitted correctly.
Beginning October 31, 1994, if it's not, we're going to return it
to you.

After reviewing this newsletter, if you're a provider who is doing
everything correctly, our thanks.  If you're not, please adjust
your procedures.

If you have any questions, contact the provider consultant for your
area:
              Steve Dean   (913) 291-8227 (northern Kansas)
              Angie Martin (316) 269-1602 (southern Kansas)

jw