Blue Cross Newsletter
 

 

January 29, 2008

 

DC-08-02




 

 

To: All Blue Cross Contracting End Stage Renal Disease Facilities
From: Donna Bartee, Communications Representative
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Subject:

BCBSKS Remittance Advice – Reporting of ESRD Facility Services


On October 27, 2007 an update was made to the BCBSKS system that changed the way ESRD payments for out-of-area BlueCard claims report on the BCBSKS remittance advice.  

BlueCard claims will continue to price just like they always have based on the ESRD composite rate and maximum allowable payments.  It's only the way the RA reports the payments for BlueCard claims that has changed.

Before October 27, 2007, the remittance advice:

  • Reported each charge line billed by the provider including service date, HCPCS and charge.
  • Reported the amount allowed for each charge line.  This amount represented the actual MAP for the service billed on the charge line.
  • Providers could verify BCBSKS' allowance by comparing the allowance reported on each charge line to the expected reimbursement for that line.

Starting October 27, 2007, the remittance advice:

  • Will continue to report each charge line billed by the provider including service date, HCPCS and charge.
  • Will show an allowed amount for each charge line but this amount now represents a systematically prorated amount based on the allowance for the entire claim. 
  • Providers can no longer verify BCBSKS' allowance by comparing the allowance reported on each charge line to the expected reimbursement. 
  • Providers will need to verify the allowance by comparing the expected reimbursement for the entire claim to the allowance reported for the entire claim on the subtotal line of the RA.    

The change that occurred only affects the way BlueCard payments for out-of-area members report on the remittance advice.  

No change was made in the way payments for local BCBSKS members report on your remittance advice.

Drb