July 23, 2010
|To:||All Blue Cross Contracting Providers|
Cindy Garrison, CPC – Education/Communication Coordinator
Medicare Advantage Billing Reminder
This notification is a reminder that Blue Cross and Blue Shield of Kansas (BCBSKS) needs to receive certain data elements in order to adjudicate Medicare Advantage claims accurately and timely. Please note that you may already be submitting these data elements, as appropriate, on Medicare Advantage claims.
How do you identify a Medicare Advantage member?
Medicare Advantage members have distinctive product logos on their medical ID card to help you recognize them. All logos have Medicare Advantage in the design – see the examples below.
Why are we reminding you about provider billing?
Most providers supply all the information we require to adjudicate claims. However, some providers miss certain critical data elements that are needed to process Medicare Advantage claims.
Providers treating Medicare Advantage members must ensure that they send in clean claims with all necessary data to BCBSKS according to the Medicare Managed Care Manual.
The data elements identified below need to be included on Medicare Advantage claims sent to BCBSKS to ensure that claims will be paid accurately and timely. The Centers for Medicare & Medicaid Services (CMS) already requires providers to bill with these elements for traditional Medicare.
Providers must include the following data elements on Medicare Advantage claims, when applicable:
What happens if you don’t include these data elements, as appropriate, on claims?
Failing to provide the necessary data elements on a claim, when applicable, may delay payment of the claim. We may have to call you to verify the data or return the claim to you.
Where do you submit the claim?
You should submit the claim to BCBSKS under your current billing practices. Do not bill Medicare directly for any services rendered to a Medicare Advantage member.
Who do you contact if you have a question about the data elements?
If you have any questions regarding the Medicare Advantage program or products, please contact your provider consultant.