August 17, 2010

BC-10-12
HP-10-11
SA-10-11

HHA-10-11
DC-10-10
MS-10-11

Cindy Garrison, CPC – Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

UPDATE: Medicare Part A Crossover Problem

In a previous newsletter, BCBSKS advised you of an issue with the Medicare Part A system that is only effecting the 837 institutional claims (BC-10-11). 

Originally, CMS targeted a fix to correct the matter in early September 2010.  BCBSKS has been notified that the fix was moved forward and corrected August 12, 2010.  For any claims submitted to Medicare between June 7, 2010 and August 12, 2010, PROVIDERS WILL NEED TO SUBMIT THOSE CLAIMS TO US.  Providers can obtain a Detailed Error Report (RPT 114) from WPS.  This report will identify all your claims that did not cross over to any secondary carrier.

Remember, that an electronically submitted claim must reflect:

• all necessary payment information indicated on the Medicare RA (ie patient responsibility, Medicare allowable, etc)
• the Medicare Adjudication Date in 2330B with a 573 qualifier.

And a paper submitted claim must include:

• a UB04
• the Medicare RA.  Circle or mark the payment information that needs to be processed (limit one request per page).
  1. If there are multiple payments or patients on the Medicare RA, duplicate that page and submit a separate copy for each case that needs handled.
  2. Make sure the patient's name and BCBSKS identification number is reflected on the Medicare RA.

As mentioned in BC-10-11, our Electronic Data Interchange (EDI) department temporarily implemented a change to allow Medicare secondary to BCBSKS claims to be filed without waiting 15 days from the Medicare RA date.  The 15 day edit will be reinstated effective August 30, 2010. 

If you have any questions regarding the submission of an electronic claim, please contact our EDI department at 1-800-472-6481.

cg