October 2016

Government Programs Upcoming Changes Affecting Claims Handling and Post-Adjudication Process, Effective Jan. 1, 2017

A number of upcoming changes will 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. The changes, effective January 1, 2017, 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 January 1, 2017. Providers 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.
  
  Please note, 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.

New Payment Cycle

• Payment cycles will be changing from daily to weekly. Blue Cross Medicare Advantage will make payments each Friday.

Paper claim mailbox address and fax number for non-delegated providers (no changes for delegated groups)

• The 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

• New format for EFT and paper checks is expected. Details will be updated with future communications.
• A new process will be implemented for claims overpayment recovery. All letters, remittance advice, vouchers, lockbox and provider manual details will be updated with 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.

BCBSNM will be providing additional information on these changes in the coming months on bcbsnm.com/provider and in upcoming issues of the Blue Review. If you have any questions or need additional information, contact your Provider Network Representative at (505) 837-8800 or toll-free (800) 567-8540. Blue Cross Medicare Advantage and Blue Cross Medicare Advantage Dual Care plans are HMO, HMO-POS, PPO, and HMO Special Needs Plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract and a contract with the New Mexico Medicaid program. Enrollment in HCSC’s plans depends on contract renewal.