October 17, 2006

BC-06-14
HP-06-12
SA-06-10

HHA-06-12
DC-06-11

All Blue Cross Contracting Providers

Online Claim Status and Medicare Crossover for Out-of-Area BCBS Members

At a recent hospital workshop, we clarified several issues relating to claim handling for out-of-area members.  Because these issues affect all providers, we’re sharing this information with you.  

ONLINE CLAIM STATUS FOR OUT-OF-AREA MEMBERS

Question:  Can a provider use the BCBSKS Web site to obtain claim status information about a claim for an out-of-area member even if it wasn’t processed and paid by BCBSKS?

Answer:  Yes.  After you submit an inquiry for an out-of-area member, our system will access and retrieve the claim status information from the other BCBS plan.  Response time may take up to 50 seconds.

For complete details about online claim status and eligibility for out-of-area members, see our November 22, 2005 newsletter.   

MEDICARE CLAIM CROSSOVER

Question:  After Medicare pays a claim will their payment information automatically crossover if the patient is enrolled in an out-of-area BCBS plan?

Answer:  Medicare payment information for out-of-area members will not crossover to BCBSKS but it can crossover to the member’s home Blue Plan if:

• the Medicare claim included the correct Blue Plan name as the secondary payer,
• the Medicare claim showed the members ID number including the alpha prefix, and
• the member was listed on the eligibility file submitted to the Medicare coordination of benefits contractor by the patient’s BCBS plan. 

Question:  How does the provider know if a Medicare claim crossed over to the patient’s secondary insurance?

Answer:  The Medicare remittance advice will reflect a claim status code 19.

Question:  If the Medicare remittance advice does not show that a claim crossed over (claim status code 19 is not on the RA), can I go ahead and submit a paper claim to BCBS for payment?

Answer:  Yes.  Please remember that all claims for out-of-area members MUST be submitted to BCBSKS.   Kansas providers should not send claims to the out-of-area member’s home plan.

Question:  If the Medicare remittance advice reflects that the claim crossed over (claim status code 19 is on the RA) but I haven’t received payment should I go ahead and send another claim to BCBSKS?

Answer:  No.  The first thing you need to do is use the BCBSKS Web site and check the status of the original claim.  By determining the status of the original claim, you’ll know what, if any, activity is necessary on your part.  

For more details about crossover, refer to our March 15, 2006  newsletter titled Medicare Claims – Consolidated Crossover Process
(BCBS Claims Secondary to Medicare).

After checking the status of the claim on the BCBSKS Web site, if you still have questions, call 1-800-432-3990.

Drb