February 11, 2011

ASC-11-04

To:

All Blue Cross Contracting ASC Providers

From:

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

Subject:

Converting to UB-04/837I Claim Format Billing

IT'S TIME
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.

THE BENEFITS
Some of the reasons that this move would be beneficial to both the ASC and BCBSKS are listed below:

  1. 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.
  2. Payment guidelines are complicated using the CMS-1500 to make a facility payment.
  3. UB-04 claim submission would bring ASCs in line with how other facility claims are edited.
  4. 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.
  5. 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

  1. Developing an impact assessment plan
  2. Implementation preparation
  3. "Go Live" preparation
  4. Post-implementation Follow-up

1. Develop an impact assessment plan

2. Implementation preparation

3. "Go Live" preparation

4. Post-implementation Follow-up

WHAT BLUE CROSS IS DOING NOW
BCBSKS is

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.

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