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May 4, 2012

Clarification of Claims Submission Reminder posted March 30, 2012

To further clarify the instruction posted on "Latest News" March 30, 2012, below is an outline of additional PAPER claim (CMS 1500) requirements added to mirror electronic 5010 submissions:

  • Box 3 must contain the patient's date of birth
  • Box 6 must indicate the patient's relationship to the member
  • Box 11a must contain the member's date of birth IF the first line of box 11 contains anything other than the word "same"
    Note: "Same" indicates the member is the patient; and therefore; the date of birth is the same.

When BCBSKS denies something JP internally, it receives the following HIPAA reason/denial:

16: CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION. AT LEAST ONE REMARK CODE MUST BE PROVIDED (MAY BE COMPRISED OF EITHER THE NCPDP REJECT REASON CODE, OR REMITTANCE ADVICE REMARK CODE THAT IS NOT AN ALERT.)

in tandem with the remark:

MA60: MISSING/INCOMPLETE/INVALID PATIENT RELATIONSHIP TO INSURED.

 Please call your professional relations representative or the Provider Network Services at 1-800-432-3587 or 785-291-4135, option 1, if you have any questions.

Thank you!