April 7, 2005

BC-05-10              HHA-05-05
HP-05-05              DC-05-05
Freestanding Rural Health Clinics

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

This newsletter includes information about:

• How to request an update to the BCBSKS eligibility file.
• Checking online claim status before submitting a paper claim.
• How to submit a paper request to BCBSKS for payment of Medicare balances.

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:

• Contact the BCBSKS customer service center and ask them to verify the information that's loaded on the eligibility file that we send to Medicare. Be prepared to furnish customer service with:
  • Medicare health insurance (HI) number,
  • Medicare effective dates (Part A & B)

Contact the BCBSKS customer service center at:

Topeka Local (785) 291-4182
Toll free 1-800-648-1756

• Send to BCBSKS a copy of the third screen of the provider CWF file from the Medicare FISS system. This screen shows the Medicare health insurance number as well as the Part A & B effective dates. Be sure to include the BCBSKS ID number along with a note that says "Update Crossover File". You can fax this information to:
  
  BCBSKS customer service center 785-290-0711

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. To learn more about Using Secured Services including how to establish a provider profile, visit our Web site at http://www.bcbsks.com/CustomerService/Providers/using_secured_serv.htm

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:

• Send a copy of the Medicare remittance advice that clearly reflects:
• Provider name and address
• Medicare provider number
• Blue Cross provider number

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.

• 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 a UB-92 claim form (or identifiable facsimile) that reflects the codes and charges billed to Medicare.

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.

• Before submitting a paper claim, BCBSKS suggests that you use the claim status section of the BCBSKS Web site to see if the claim has already been processed.

drb