Jan. 07, 2011
BCBSKS Claims Secondary to Medicare
A new year is here and with a new year comes new Medicare deductibles. The new deductibles are applied to claims with dates of service January 1 and after. This can create problems for those expecting Medicare primary claims to auto crossover to Blue Cross and Blue Shield of Kansas (BCBSKS) and be paid automatically.
Crossover issues have, for the most part, gone away. BCBSKS periodically experiences issues with certain claims that have been processed by Medicare. These issues include the following:
- Third party payer on the claim
- Medicare is now the primary payer and is not loaded to BCBSKS system
- The Medicare information loaded to BCBSKS system is incorrect
- A negative Medicare paid amount is present on the claim
Historically, higher than normal volumes of these claims issues present themselves during the first quarter of each year. With the implementation of HIPAA version 5010, January 1, 2012, these issues are anticipated to be resolved.
If you experience BCBSKS secondary to Medicare claim problems, please contact BCBSKS Customer Service Center for assistance in researching why the claim did not automatically cross over from Medicare.
If your BCBSKS Secondary to Medicare claim did not automatically cross over, please submit the claim electronically 15 days after the Medicare adjudication date. Include all Medicare processing information found on the remittance advice such as:
- The total amount billed
- Medicare paid amount
- Medicare contractual write-off
- Non-covered portion (if applicable)
Without all the pertinent information BCBSKS cannot "balance" the claim and assure that correct reimbursement is made.
If BCBSKS cannot "balance" the claim, you will receive a letter requesting that you resubmit a paper claim with a copy of the Medicare RA to insure proper processing of the claim. This only delays processing and adds additional costs to your office and ours as well.
Filing a paper claim including RA should be the last resort.
If you are having difficulties submitting secondary claims successfully to BCBSKS, please contact the EDI Help Desk @ 1-800-472-6481. They will work with you so that you can submit your claims electronically.