Blue Cross Newsletter
 

 

November 22, 2005

 

BC-05-22
HP-05-15
SA-05-13

 

HHA-05-16
DC-05-15

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: Online Claim Status and Eligibility for Out-Of-Area Members

Blue Cross and Blue Shield of Kansas is pleased to announce that online claim status and eligibility information for out-of-area members is now available through the BCBSKS Web site. 

This new feature is sponsored by the Blue Cross and Blue Shield Association and allows BCBS plans from various states the ability to send select HIPAA transactions, claim status and eligibility requests for patients who are not a member of the local BCBS plan and receive information back regarding that inquiry.

Here are some important details about this new feature:

  • All access for both local and out-of-area information is through the same "secured services" section of the BCBSKS Web site.  From the "user services" menu, select either claim status or eligibility.
  • Most of the same online screens that you use today for claim status and eligibility information for local members will be used to obtain information for out-of-area members.
  • The identification number you enter must include an alpha prefix.  The system uses the alpha prefix to determine if the inquiry is for a Kansas member or an out-of-area member.  Most alpha prefixes are three characters however FEP members are identified by a single character alpha prefix of "R". 
  • If the ID number you enter is for an out-of-area member (including FEP), the system will display another screen that's new for out-of-area inquiries and you will be required to furnish more information.
    • For claim status inquiries this includes detailed information about the member and patient (name, date of birth, gender, relationship to insured, etc.), service date and total charges.  You may also enter other optional details about the claim.
    • For eligibility inquiries this includes detailed information about the member and patient (name, date of birth, gender, relationship to the insured, etc.) and the service date.

NOTE:  FEP members are considered out-of-area members.  If the ID number you enter begins with a single character alpha prefix "R", this new screen will be required.

  • After you "submit" the inquiry, the system will display the claim status or eligibility information in the same basic format that you currently see for local members. 
    • The "Patient Claim Status Response" screen for Kansas's members includes a link for viewing the remittance advice and a patient claim details screen.  These two features are not available for out-of-area members but will continue to be available for local members.   
    • Because out-of-area inquiries are accessing information from other plans, response time may take up to 50 seconds.

After using the online inquiry process, if you need additional information, contact:

         

BlueCard Program
 -benefits and eligibility for out-of-area members

1-800-676-BLUE (2583)

BlueCard Program
-claim inquiries for out-of-area members

1-800-432-3990 ext 4058

Provider Benefit Line
-benefits and eligibility for Kansas members

1-800-432-0272

BCBSKS customer service center
-claim inquiries for Kansas members

1-800-432-3990

 

BCBSKS is excited about this enhancement to the online services we offer to providers.  Because this process for out-of-area members is new, if you see something that doesn't appear to be displaying as you think it should, please contact us using the feedback form.

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