Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

January 2017

Important Changes Impacting Claims Submissions for Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM

Last month’s Blue Review included a preview of changes that became effective Jan. 1, 2017, as part of a Blue Cross and Blue Shield of Texas (BCBSTX) initiative to improve efficiencies in claims-related processes for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) member claims. This month, we’re following up with additional details, important reminders and related resources, including:

Electronic Payer ID
(for claims received by
Jan. 1, 2017)		 New Payer ID – 66006
Effective Jan. 1, 2017, claims received must be submitted with PAYER ID 66006. Providers should no longer use commercial Payer ID 84980 for Blue Cross Medicare Advantage Plans. If you use a practice management/hospital information system or billing service, and/or a clearinghouse other than Availity® or Passport/Experian® for electronic claims submissions, contact your vendor to confirm they are using the new Payer ID 66006.
Member ID Number Prefixes
State PPO HMO
Texas ZGD ZGJ
Illinois XOD XOJ
New Mexico YID YIJ
Oklahoma YUX YUB
Montana YDJ YDL
Claims with the above member ID number alpha prefixes must be submitted using the new Payer ID 66006, even for members seeking 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 Eligibility and Benefits Via Availity
(for services rendered on or after Jan. 1, 2017) 		There is a new Blue Cross Medicare Advantage option in the drop-down menu on the Availity web portal for registered users.
Paper Claim Submissions – Mailing Address for Non-delegated Providers*
*Effective Feb. 1, 2017, claims received at the old mailbox will be rejected with a letter informing providers to resubmit to the new mailbox.

As of Feb. 1, 2017, be sure to mail paper claims to:
Blue Cross Medicare Advantage
c/o Provider Services
P.O. Box 3686
Scranton, PA 18505
Claim Payment Cycles and New Format for Electronic Funds Transfer (EFT)
  • Effective Jan. 1, 2017, claims payments will be made on a weekly basis instead of daily.
  • On electronic payments, the EFT trace number will start with a source code of “M” instead of “C.”
Electronic Claim Status Submit electronic claim status inquiries (HIPAA 276 transactions) through Availity or your preferred vendor portal. Beginning Jan. 1, 2017, the Claim Research Tool on the Availity web portal is no longer be available.
Electronic Remittance and Provider Claim Summary (PCS)
  • 835 Electronic Remittance Advice (ERA) files will be distributed to the address/receiver ID associated with the billing provider’s Tax ID, rather than being distributed to multiple locations/receivers.
  • The Electronic Payment Summary (EPS) from BCBSTX will no longer be sent with the 835 ERA.
  • Effective Jan. 1, 2017, paper PCSs will be sent by mail to ERA and non-ERA receivers.
  • The electronic Payer ID on the 835 ERA will now match the Payer ID that is submitted on the claim. Effective Jan. 1, 2017, the new Payer ID for claims is 66006.
  • For current 835 ERA receivers, there is no need to re-enroll to continue receiving electronic remittance information for claims.
Overpayment Recovery Effective Jan. 1, 2017, a new process has been implemented for claims overpayment recovery.
  • The Electronic Refund Management and Claim Inquiry Resolution tools on Availity will no longer be available.
  • Request for refund letters will be sent by mail for all providers.
  • Beginning Jan. 1, 2017, providers may submit requested and voluntary refunds to:
Blue Cross Medicare Advantage
c/o Provider Services
P.O. Box 3686
Scranton, PA 18505

Additional Information
We appreciate your patience during this transition. The Provider Manuals, 835 ERA/EFT Companion Guides and other resources were updated as of Jan. 1, 2017. These changes will be noted on the BCBSTX provider website and in the provider manuals accordingly. Please continue to watch for further updates on the website and in this newsletter.

Eligibility Notice
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.