July 12, 2013

HHA-13-6
DC-13-6
ASC-13-7
MS-13-8

BC-13-8
SA-13-6
HP-13-6

To:

All Blue Cross and Blue Shield of Kansas Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Other Party Liability (OPL)

BCBSKS receives numerous calls from providers who ask who is responsible for submitting the additional information noted on their remittance advice (RA). In most cases, Other Party Liability (OPL) information is needed from the member, which is indicated on the RA with OP in the CNTR column and a “17” in the ADJUSTMENT REASON CODE column. If members call their providers about these types of claim denials, they should be instructed to contact our OPL department direct at 1-800-430-1274 or 785-291-4013 (Topeka).

An OPL Questionnaire is available on our Website at www.bcbsks.com on the provider's forms page.  We encourage providers to have patients complete the questionnaire to expedite claims processing. The questionnaire can be faxed or mailed to BCBSKS as indicated on the form.

As reflected by the total charge in the AMOUNT PATIENT OWES field on the RA, providers may bill their members for these services, and are not required to wait for the requested information to be furnished to BCBSKS.

Providers are encouraged to use the self-service tools available through the Web and Interactive Voice Response (IVR) when checking on the status of a claim or an update on the return of an OPL form. If our questionnaire has been returned, claims will have been adjusted and this information can be found through the self-service tools, including the IVR and the Availity web portal. By providers using these self-services tools, it allows BCBSKS to better serve our providers and members with issues that require personal attention.

If you have questions on this newsletter, please contact your Institutional Provider Representative.

 

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