December 2016

Important Changes Impacting Claims Submissions for BCBSTX Medicare Advantage Plans

Effective Jan. 1, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) will administer updates and changes that will have an impact on claims submissions for Medicare Advantage (PPO)^SM and Blue Cross Medicare Advantage (HMO)^SM (Medicare Advantage plans). These changes will assist in streamlining claims processing and improving efficiencies of claims routing to our primary claims adjudicator.

The changes are as follows:

New Payer ID

• 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 Experian^® Health (ecare online) should contact their clearinghouse to confirm the new Payer ID for this plan (as other clearinghouses may assign their own unique number).
• Please note that the Blue Cross Medicare Advantage member ID cards will contain the following applicable state alpha prefix:

• The above state alpha prefix must be submitted using the new Payer ID 66006, even for members who seek services from you when out of state.  You will no longer use the commercial payer IDs for out-of-state members with these prefixes.  Claims with these prefixes will be rejected if submitted to the commercial payer ID.

Electronic Inquiry Submission Updates

• Effective for services rendered on and after Jan. 1, 2017, Blue Cross Medicare Advantage eligibility, and benefit and claim status inquiry transactions will have a new drop-down with payer options available within the Availity web portal.
• Blue Cross Medicare Advantage providers will no longer have access to the Claim Research Tool on Availity. Claim status can be obtained through Availity or your current web vendor via the electronic 276 claim status inquiry process.

New Electronic Funds Transfer (EFT) Payment Cycle

• Payment cycles for EFT will be changing from daily to weekly. BCBSTX will make weekly EFT payments for Blue Cross Medicare Advantage plans effective Jan. 1, 2017.

Paper Claim Mailbox Address and Fax Number for Non-delegated Providers
(No changes for RPO/EPIC/VOP providers)

• The paper claim mailbox address and fax number for Blue Cross Medicare Advantage Plans non-delegated providers will change to:
  

Blue Cross Medicare Advantage
c/o Provider Services
P.O. Box 3686
Scranton, Pa. 18505
Fax: 855-674-9192

• Effective Feb. 1, 2017, claims received at the old BCBSTX mailbox will be rejected with a letter informing providers to resubmit to the above correct mailbox.

New Processes and Format for Payments

•  EFT trace number:
• Blue Cross Medicare Advantage Plans will start with a source code of “M” instead of “C”
• A new process will be implemented for claims overpayment recovery:
• ERM (Electronic Refund Management) claims refund and inquiry process post Jan. 1, 2017, will not be available through ERM.
• Request for refund letters will be sent by mail for all providers.
• Providers may submit requested and voluntary refunds to the new lockbox listed above.

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.
• EPS (Electronic Payment Summary) will not be available for providers post Jan. 1, 2017. However, for ERA and non-ERA receivers, Provider Claim Summaries (PCS) will be sent by mail.
• As a current ERA receiver for Blue Cross Medicare Advantage plans, you will not need to re-enroll under the new Payer ID.
• The Payer ID on the 835 ERA will now match the Payer ID that is submitted on the claim (if submitting Blue Cross Medicare Advantage claims using 66006, then the ERA Payer ID will also reflect 66006).

We appreciate your patience during this transition. BCBSTX will be providing additional information on these changes in the coming months. These changes will be noted on the BCBSTX website and in the provider manuals accordingly. Please continue to watch for further information on the BCBSTX website and in this newsletter.

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 may 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, LLC. Availity is a partially owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. Availity operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX, a Division of HCSC. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions about the products or services offered by such vendors, you should contact the vendors directly.