Blue Cross Newsletter

January 4, 2001                                      BLUE CROSS NEWSLETTER
                                                     *********************


TO:  FREESTANDING RURAL HEALTH CLINICS

FROM:  Donna Bartee, Communications Representative
       Institutional Relations
       Blue Cross and Blue Shield of Kansas, Inc.
       An Independent Licensee of the Blue Cross and Blue Shield Association


SUBJECT: MEDICARE CLAIM CROSSOVER FROM RIVERBEND
         ***************************************

We are pleased to announce that Blue Cross and Blue Shield of Kansas, Inc.
is now set up to receive Medicare payment information electronically from
Riverbend.  Riverbend serves as the Medicare intermediary for most of the
freestanding rural health clinics located in the state of Kansas.  This
process is called automatic crossover.  What will happen is, BCBSKS will
furnish Riverbend a monthly eligibility file of our insureds who have a
complementary to Medicare coverage.  When Riverbend processes a claim, if
they can match the beneficiary to someone on our eligibility file,
they will pass or crossover the Medicare payment information to BCBSKS.

We will then consider the Medicare deductible/coinsurance amounts for
benefits under our insured's contract.

For the most part, this change means that BCBSKS will be able to process
the Medicare balances without you submitting any paper information to us.
There may be isolated cases when information does not crossover. An example
could be an insured who is new to BCBSKS and therefore is not yet on the
eligibility file we give to Riverbend or maybe BCBSKS does not have the
Medicare information loaded on our enrollment file.  When things like
this occur, the automatic crossover will not work and then the provider
will have to submit the paper information to us.  If you happen across
a particular insured whose payment information never seems to crossover
from Riverbend, contact our customer service center and they can review
our enrollment file to see if it includes accurate Medicare information.

In the event that you do need to send a paper request to us, here is
a 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

NOTE: 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.

--  On the Medicare remittance advice, CIRCLE OR BRACKET 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 for 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.

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).

Questions on individual accounts should be directed to the Blue Cross
customer service center:
                   Local Topeka   (785) 291-4180
                   toll free      1-800-432-3990
       Plan 65 csc local Topeka   (785) 291-4182
       Plan 65 csc toll free      1-800-648-1756

Questions regarding this newsletter should be directed to the institutional
relations department.

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