Electronic Data Interchange (EDI)

Blue Cross and Blue Shield of Kansas New Warning Edits March 1, 2009

Beginning March 1, 2009, new warning edits will be implemented for 90 days. These edits are for Blue Cross and Blue Shield of Kansas secondary to Medicare claims filed prior to 30 days after Medicare payment/non payment.

Edit Description

B386B – ICN not present on BS Secondary to MB claim
Logic 2010BB equals 47163, 2000B SBR01 equals 'S' or 'T', 2320 SBR01 equals 'P', 2300 NTE01 must equal ADD and NTE 02 is present

B387 – Claim Adjudication Date not present
Logic 2330B DPT01 equals 573

B388 – Claim Adjudication Date must be GTE today minus 30 days.
Logic 2330B DTP03 must be 30 days greater than or equal to date in BHT04

B386A – ICN not present on BC Secondary to MA claim.
Logic 2010BB equals 47163, 2000B SBR01 equals 'S' or 'T', 2320 SBR01 equals 'P', 2300 NTE01 must equal ADD and NTE 02 is present

Beginning August 2, 2009 the warning will be changed to a rejection.

If submitting Blue Cross and Blue Shield of Kansas secondary to Medicare claims electronically, they must reflect:

Medicare ICN in the2300 NTE with ADD qualifier
Medicare Adjudication Date 2330B with a 573 qualifier
Medicare Adjudication Date must be equal to or greater than 30 days than the claim filing date.

When submitting secondary claims, the claim must reflect all, and the same information reported on the primary payer remittance advice for proper adjudication of the claim.