April 7, 2005
|To:||All Blue Cross Contracting Hospitals, End Stage Renal Disease Facilities, Home Health Agencies and Hospice Agencies|
|To:||Freestanding Rural Health Clinics|
Donna Bartee, Communications Representative
|Subject:||BCBSKS Claims Secondary to Medicare
This newsletter includes information about:
HOW TO REQUEST AN UPDATE TO THE BCBSKS ELIGIBILITY FILE
If everything works like it should, after Medicare processes a claim if the patient has BCBSKS as their secondary payer, the information should automatically crossover to BCBSKS so that we can process the eligible balances.
Both of us know that sometimes this doesn't happen and part of the reason is because BCBSKS does not have the patient identified on the eligibility file that we send to Medicare. You can help us correct this problem.
When you identify accounts that didn't automatically crossover, you can:
CHECKING ONLINE CLAIM STATUS BEFORE SUBMITTING PAPER CLAIMS.
Providers and in particular rural health clinics send to BCBSKS a sizeable number of paper claims requesting payment of Medicare balances. BCBSKS estimates that about 30% of these claims are duplicates. Before sending a paper claim to us, we suggest that you use the BCBSKS Web site ( www.bcbsks.com ) and check to see if the claim has already processed.
BCBSKS claim status information is secure information and requires the user to establish a provider profile with Availity.
HOW TO SUBMIT A PAPER REQUEST TO BCBSKS FOR PAYMENT OF MEDICARE BALANCES.
These instructions have been updated.
If a provider needs to submit a PAPER request to BCBSKS for the payment of Medicare balances, here's what you need to do:
NOTE FOR RHCs: when you became Medicare certified as a rural health clinic, BCBSKS assigned you a Blue Cross provider number to be used ONLY for paying claims secondary to Medicare. This Blue Cross number is entirely different than your regular Blue Shield number and the two are NOT INTERCHANGEABLE.
NOTE FOR RHCs: Rural health clinics can include either a UB-92 claim form (or identifiable facsimile) or a CMS 1500 claim form that reflects the codes and charges billed to Medicare.