Blue Cross Newsletter
 

 

March 18, 2003

 

BC-03-06
HHA-03-04

 

DC-03-04
HP-03-04

  Freestanding Rural Health Clinics
To: All Blue Cross Contracting Hospitals, End Stage Renal Disease Facilities, Home Health Agencies and Hospice Agencies
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: Obtaining Payment From Blue Cross For Medicare Balances

On April 1, 2003, Blue Cross and Blue Shield of Kansas (BCBSKS) will upgrade the current system to coincide with the migration to the ANSI standards (ANSI ASC X12N) as mandated by HIPAA.

Because the HIPAA regulations have guidelines relating to the reporting of billed revenue and HCPCS codes, if a provider needs to submit a PAPER request to BCBSKS for the payment of Medicare balances, a copy of the UB-92 claim form (or an identifiable facsimile of a UB92) that reflects the codes and charges billed to Medicare must be included. You should already be including a copy of the UB-92 on your payment requests for Medicare exclusion rider (MER) contracts but you had not previously been required to do so for Plan 65 contracts.

Beginning with requests received by us April 1, 2003 and after (regardless of service date), a copy of the UB-92 (or identifiable facsimile) will be required on ALL secondary to Medicare payment requests submitted to BCBSKS. If a request is received without all the required information, it will be returned to the provider.

This change does not affect accounts that automatically crossover from Medicare to BCBSKS. These will continue to process just as they do today.

A complete recap of the correct procedures to use when submitting information for processing of Medicare balances appears below. These procedures are effective for requests that would be received by BCBSKS April 1, 2003.

  • Send a copy of the Medicare remittance advice which clearly reflects:
    • Provider name and address
    • Medicare provider number
    • BCBSKS provider number

NOTE FOR RURAL HEALTH CLINICS: when rural health clinics became Medicare certified, BCBSKS assigned them a Blue Cross provider number that is used only for paying balances after Medicare's payment. This Blue Cross 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 (limited to one request per page).
  • If you have multiple payments or patients on the same page of the remittance advice that need to be processed by BCBSKS, you will need to duplicate that page and submit a separate copy for EACH CASE that needs handled.
  • Make sure the patient's name and BCBSKS identification number is reflected on the remittance advice.
  • Circle the deductible/coinsurance fields on the Medicare remittance advice.
  • Include a copy of the UB-92 claim form (or identifiable facsimile) that reflects the codes and charges billed to Medicare. DO NOT submit a CMS 1500 claim form. It must be a UB-92.

Again, these instructions apply to payment requests received by BCBSKS beginning April 1, 2003. The actual service date is not an issue it's based strictly on when BCBSKS receives the request.

Drb