Q. If a member sees a provider not located in a county where Medicare Advantage (MA) is offered, how is that going to impact the ability to provider services and reimbursement?
A. The MA territory is where the MA product is sold. Regardless of where the service takes place, MA members have different benefits for in- and out-of-network. Contracting and non-contracting providers should file a claim on the member's behalf. Minus the member's out-of-pocket benefits, reimbursement will go directly to contracting providers and to members who see non-contracting providers. Providers interested in contracting for MA should email [email protected] with provider name and billing NPI.
Q. What is the claims mailing address for Medical and Dental?
A. Medical claims, being filed on paper need to be mailed to:
Kansas Preferred Blue Medicare Advantage
PO Box 239
Topeka, KS 66629
Dental claims being filed on paper need to be mailed to:
Blue Cross Blue Shield Kansas
PO Box 1126
Elk Grove Village, IL 60009
Q. Will payments show on a regular Blue Cross and Blue Shield of Kansas (BCSBKS) Remittance Advice?
A. No, payment will show on a separate MA Remittance Advice.
Q. Who is processing MA claims?
A. BCBSKS has partnered with the following vendors who will handle all of the benefits and claims processing:
Advantasure – Medical
Dominion – Dental
EyeMed – Vision
TruHearing – Hearing
Q. When did MA policies become effective?
A. January 1, 2020
Q. How are Rural Health Clinics serviced billed and paid under MA?
A. RHC services are to be billed on a UB92 claim form under the RHC billing NPI for contracting or non-contracting RHCs. Send a copy of the RHC rate letter to [email protected] to insure correct payment on RHC claims.
Q. If a patient is seen in a county that is not in the designated MA territory, does the provider handle them as self-pay?
A. The MA territory is where the MA product is sold. Regardless of where the service takes place, MA members have different benefits for in- and out-of-network. Contracting and non-contracting providers should file a claim on the member's behalf. Minus the member's out-of-pocket benefits, reimbursement will go directly to contracting providers and to members who see non-contracting providers.
Q. Who does a provider contact with claim issues?
A. Provider Services at 800-240-0577.
Q. Will BCBSKS and our local provider representatives have access to the claims processing systems?
A. No, providers will need to contact Provider Services at 800-240-0577.
Q. Is it recommended that we submit Prior Authorizations for MA members like we do for regular business?
A. No, currently Prior Authorizations are not required for professional services, however, this could change in 2021. Providers are welcome to request an Organization Determination if there is concern the service to be provided may not be covered by Medicare (refer to the Medicare Advantage Provider Manual for specific instructions).
Q. Will MA plans pay for pelvic and breast exams every two years like regular Medicare?
A. Yes, these services will be paid every two years.
Q. Is BCBSKS allowing MA members to have it as primary as well as a supplemental Plan 65 policy?
A. MA is an all-inclusive benefit program that does not allow for a supplemental benefit coverage. A supplemental benefit is not needed with MA products.
Q. Does BCBSKS reimburse at the Federally Qualified Health Center (FQHC) rate?
A. Yes, BCBSKS does follow Medicare's fee schedule for FQHC.
Q. Does an FQHC bill on a UB-04 claim form like Original Medicare?
A. Yes, FQHC services are to be billed on a UB-04 claim like regular Medicare.
Q. Are BCBSKS providers automatically contracted for MA?
A. No, BCBSKS providers are not automatically contracted for MA. Providers interested in contracting for MA should send an email to [email protected] with provider name and billing NPI. A contract will be emailed to the provider Providers should contact their professional relations representative with any questions related to contracting.
Q. Is there a specific Advanced Beneficiary Notice of Non-Coverage (ABN) for MA?
A. Yes, a link to the ABN is on the BCBSKS MA Provider webpage. Click here for a direct link.
Q. How will BCBSKS communicate/monitor the claims process? Daily, weekly, monthly, etc.?
A. Claims reports are received and worked daily.
Q. What do the Blue MA member ID numbers look like?
A. All of Blue MA member ID numbers begin with M3AK and are followed by eight numerical digits (refer to the Medicare Advantage Provider Manual for a sample member ID card).
Q. Are modifier requirements the same as regular Medicare?
A. Yes, BCBSKS accepts all Medicare approved codes and modifiers.
Q. Is the payer ID the same for electronic MA claims as it is for BCBSKS claims?
A. Yes, the payer ID is 47163.
Q. Do providers call BCBSKS Customer Service for MA-related questions?
A. No, providers are to contact Provider Services at 800-240-0577.
Q. How does a provider look up MA member benefits and eligibility?
A. Medical benefits and eligibility are available in Blue Access via Availity. If pulling benefits and eligibility using the member ID number be sure to leave off the M3A and add 00 at the end of the last numeric digit on the ID card.
Dental benefits and eligibility are accessed on the Dominion site via Availity. If pulling benefits and eligibility using the member ID number be sure to leave off the M3AK and add 00 at the end of the last numeric digit on the ID card.
Q. How long will it take to process a claim and receive payment?
A. Blue MA will process and pay clean claims within 30 days of receipt. Non-clean claims can take up to 60 days to process and pay.
Q. Will interest be paid on claims that are not processed within 30 days?
A. Yes, interest is paid at the same rate as CMS on claims not processed within 30 days.
Q. I have been seeing a patient for years who has retired from a company that offers MA coverage to its retirees. How does that impact my patients who are MA members of a retiree group?
A. More employer groups are offering MA benefits to retirees known as Employer Group Waiver Plans (EGWP). The impact to the retiree is the ability to maximize benefits (in-network vs. out-of-network). If you are not contracted as BCBSKS MA provider, send an email to [email protected] for a contract.