Cindy Garrison, CPC – Education/Communication Coordinator
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Converting to UB-04/837I Claim Format Billing
It is time to move forward with converting Ambulatory Surgical Centers (ASC) from billing on a CMS 1500 to billing on a UB-04. Starting January 1, 2012, ASCs will begin to submit all their services to Blue Cross and Blue Shield of Kansas (BCBSKS) using the UB-04/837I claim format.
Some of the reasons that this move would be beneficial to both the ASC and BCBSKS are listed below:
Currently the Federal Employee Program (FEP) uses a system which cannot accept the CMS-1500 claim form. BCBSKS currently changes the CMS-1500 to the UB-04 format before sending the claim for processing. In addition, when the claim is received back from Washington, BCBSKS then again converts it back to the CMS-1500 form for reporting on the remittance advice to providers. This process causes delays the payment to the providers. This timeframe could be shortened if this conversion was eliminated.
Payment guidelines are complicated using the CMS-1500 to make a facility payment.
UB-04 claim submission would bring ASCs in line with how other facility claims are edited.
ASCs would follow facility medical policies which allow for a 30 day notification to update systems. Comment periods for draft policies would remain in tact.
The maximum allowable payment (MAP) listing was developed for facility providers and can be confusing when using it with respect to professional billing guidelines and rules as it doesn't address content of service, multiple billing guidelines, etc.
WHAT YOU SHOULD DO NOW
Providers should start
Developing an impact assessment plan
"Go Live" preparation
1. Develop an impact assessment plan
Identify key people within your organization that would need to be involved in the transition
Provide UB-04/837I awareness education to key stakeholders
Develop a detailed project plan
Coders and other coding professionals
Identify reports and forms requiring modification
Identify systems, applications, and databases that are impacted
Assess impact on documentation processes and workflow
Identify policies/procedures that need developed or revised
Talk with your vendor about
What system changes are needed to accommodate UB-04/837I claim billing
When will changes to the systems be available for testing and implementation
What customer support and training will be provided
Assess training needs
Determine who will need to attend BCBSKS training workshops
How will training be delivered
2. Implementation preparation
Complete tasks identified during Impact Assessment
Stay in contact with your vendor
Complete internal testing
Begin external testing
Develop contingency plan for continuing operations if critical system issues or other problem occur when UB-04/837I claim filing goes live
3. "Go Live" preparation
Remain in contact with BCBSKS
Stay in contact with your vendor
4. Post-implementation Follow-up
Review reports and forms
Review training needs
Claim rejects and denials
Review claim's payment
WHAT BLUE CROSS IS DOING NOW
Developing provider education materials
Developing Spring and Fall provider workshops
Finalizing our claim's system upgrades to recognize ASC submitting claims using the UB-04/837I claim format
Finalizing internal communications with
Blue Cross is excited about moving forward with this transition. As more information becomes available, it will be communicated to you via newsletters and/or from your provider consultant, Christie Blenden.
Please be sure to share this newsletter with all areas of your facility that will be submitting claims to BCBSKS.