Blue Cross Newsletter
 

 

September 12, 2005

 

BC-05-17
HP-05-10
SA-05-09

 

HHA-05-11
DC-05-10
To:

All Blue Cross Contracting Providers

From: Donna Bartee, Communications Representative
Institutional Relations
Blue Cross and Blue Shield of Kansas
An Independent Licensee of the Blue Cross and Blue Shield Association
Subject: BCBSKS Announces Implementation of Interactive Voice Response (IVR)

Very soon BCBSKS will begin using an interactive voice response system (IVR). The IVR will use an exchange of spoken information between the person calling and the system to authenticate provider telephone calls and furnish information about claim status and eligibility.

All incoming provider telephone calls for our customer service center and pre-certification department will initially be handled by the IVR. The first step the IVR will take is to authenticate the call. The authentication process differs a little depending on which department you're calling but you need to be prepared to furnish the following information:

  • Who is calling? Member or provider?
  • If provider, are you a doctor or a hospital? (This system only offers these two choices. All professional providers would say doctor and all facility/institutional providers would say hospital.)
  • Provider number
  • Telephone number
  • Patient's identification number
  • Patient's name
  • Patient's date of birth
  • Pre-certification number (if applicable)

If later your call is transferred to a customer service center representative or pre-certification analyst, this authenticated information will transfer with the call. (If your call is directed to a department other than customer service or pre-certification, the authenticated information will not transfer.)

After the authentication process:

  • If you called the pre-certification department, a pre-certification analyst will handle the remainder of your call.
  • If you called the customer service center, the IVR will ask if this call is about claim status, eligibility or some other issue. Claim status and eligibility calls will continue to be handled by the IVR. Calls about other issues will be directed to a customer service representative.

Through a spoken exchange of information between the caller and the IVR the following claim status and eligibility information is available:

CLAIM STATUS

ELIGIBILITY

  • date processed
  • level of benefit (i.e. Premier Blue, Premier Blue self referral, etc.)
  • amount paid
  • coverage level (single/family)
  • who was paid
  • effective and/or termination dates
  • total patient responsibility
  • time period (calendar year, contract year)
  • provider's contractual obligation
  • deductible amounts
  • patient coinsurance
  • coinsurance percentages and maximums
  • patient deductible
  • amounts already applied to deductible and/or coinsurance
  • patient co-payment
  • office visit copay
  • emergency room copay
  • inpatient copay

At the end of either a claim status or eligibility IVR exchange, the caller can furnish a fax number and a recap of the information will be faxed to them.

Helpful hints when using the IVR:

  • Speak in your normal tone of voice and at your regular pace.
  • Always use the member's most current BCBSKS identification number. The IVR will not recognize the old ID numbers that existed prior to the November 2004 ID number conversion.
  • Starting out, the IVR will be operational during normal working hours. Later the hours of operation will be expanded and the only time the IVR will not be available is:
    • Tuesday – Saturday: midnight to 2:00 a.m.*
    • Sunday: 6:00 p.m. to midnight*

*central time

  • Anyone who uses this system regularly will quickly become familiar with the flow of information. If you know what your response will be to a certain prompt without listening to the entire question, you can interrupt the IVR by speaking the answer at any time during the question. Remember, the IVR must start the prompt/question before it will recognize your response.

The BCBSKS IVR offers to providers a fast and easy method for obtaining accurate claims status and eligibility information. This new service is in addition to the claim status and eligibility information already available on the BCBSKS Web site www.bcbsks.com.

Drb