November 2016
Reminder: Announcing Changes that will Affect Claims Submissions for Medicare Advantage Plans Effective Jan. 1, 2017
Beginning Jan. 1, 2017, changes will affect claims submissions for our Medicare Advantage plans, including the Payer ID.
Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM will have changes that affect claims submissions for our Medicare Advantage plans. These changes will assist in streamlining claims processing and improve efficiencies of claims routing to our primary claims adjudicator.
Changes include:
- New Payer ID for Blue Cross Medicare Advantage Plans
The Payer ID for the Blue Cross Medicare Advantage plans will change to 66006 for claims submitted on and after Jan. 1, 2017. Providers who are not registered with Availity® and Passport/NEBO (ecare online) should contact their clearinghouse to confirm the new Payer ID for this plan – as other clearinghouses may assign their own unique number.
Blue Cross Medicare Advantage member ID card will contain the following applicable Texas member ID number alpha prefixes:
PPO HMO ZGD ZGJ The new payer ID 66006, should be used for submission of electronic claims for any Medicare Advantage members from the states referenced above. You will no longer use the commercial payer IDs for claims for Medicare Advantage members from those states with member ID number prefixes listed above. Claims for members with those ID number prefixes that are not submitted to payer ID 66006, on or after Jan. 1, 2017, will be rejected and the reason for the rejection will be included.
- EFT Payment Cycle
- Payment cycles will be changing from daily to weekly. Blue Cross Medicare Advantage will make daily payments.
- Paper Claim Mailbox Address for Non-delegated Providers (no changes for RPO/EPIC/VOP providers)
- Paper claim mailbox address and fax number for non-delegated providers will change to:
Blue Cross Medicare Advantage
P.O. Box 3686
Scranton, PA 18505
Fax Number: 855-674-9192
- New Processes
- A new format for Electronic Funds Transfer and paper checks is expected; details will be shared in future communications.
- A new process will be implemented for claims overpayment recovery. All letters, remittance advisers, vouchers, lockbox and provider manual details will be updated in future communications.
- Electronic Remittance Advice (835 ERA)
- 835 ERA files will be distributed to the address associated with the billing provider’s Tax ID, rather than being distributed to multiple locations.
Blue Cross and Blue Shield of Texas (BCBSTX) will be providing additional information regarding these changes in the coming months on our provider website and in the Blue Review provider newsletter.
Eligibility and Benefit Quotes
Member eligibility and benefits should be checked prior to every scheduled appointment. Eligibility and benefit quotes include membership status, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. It is strongly recommended that providers ask to see the member’s ID card for current information and a photo ID to guard against medical identity theft. When services might not be covered, members should be notified that they may be billed directly.
If you have any questions or if you need additional information, please contact your BCBSTX network management representative.
Availity is a registered trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.