Arkansas Blue Cross and Blue Shield

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1 Arkansas Blue Cross and Blue Shield November 2005 Inside the November 2005 Issue: Name of Article Page Air and/or Ground Ambulance Claims Filing Procedures 6 Attachments to Claims 8 Bill Types for Facility Claims 6 BlueCard Remittance Advice Now Available for Viewing on AHIN 6 Changes Made to the BlueCard Remittance Advice 7 Claims Denied for Timely Filing 8 Corrected Bill Submission Form 9 CPT Code Helpful Questions & Answers for Claims Filing 10 National Drug Codes (NDC) 4 New ID Cards for BlueCard Members 2 Out-of-State Blue Cross and Blue Shield Members Contacting Local Plan 8 Patient Relationship Code 3 Phone Calls to Obtain Additional Information 4 Timely Response to Fax requests for Invoice, OP Reports, or Medical Records 7 Unsolicited Refunds 5 W-9 Requests From Blue Cross and Blue Shield of Michigan 4 Please Note: This newsletter contains information pertaining to Arkansas Blue Cross and Blue Shield, a mutual insurance company, its wholly owned subsidiaries and affiliates. This newsletter does not pertain to Medicare. Medicare policies are outlined in the Medicare Providers News bulletins. If you have any questions, please feel free to call (501) or (800) Any five-digit Physician's Current Procedural Terminology (CPT) codes, descriptions, numeric modifiers, instructions, guidelines, and other material are copyright from the 2005 American Medical Association. All Rights Reserved. The BlueCard News The BlueCard News is a publication of Arkansas Blue Cross and Blue Shield. Please send your questions or comments regarding the BlueCard News to: Arkansas Blue Cross and Blue Shield Attn: Karen Green - Newsletter Editor P. O. Box 2181 Little Rock AR krgreen@arkbluecross.com

2 PAGE 2 NOVEMBER 2005 New ID Cards for BlueCard Members: Blue Cross and Blue Shield Plans across the country are in the process of removing Social Security numbers from Member ID cards for BlueCard and out-of-area members. By January 1, 2006, more than 93 million Blue Cross and Blue Shield members will have reissued member ID cards. Now, more than ever, it is important that providers use the most current Alpha Prefix and Member ID number so that claims can be properly processed. Useful Tips: Make copies of the front and back of the member s ID card. To ensure that the member furnishes the most current ID card, providers may want to request the member s ID card at every visit. Whether the most current member ID card contains a Social Security number or an alternate unique identification number, please enter the identification number exactly as it appears on the member s ID card, including the three-character alpha prefix. The member s ID card will always include the Alpha Prefix in the first three positions. Do not make up alpha prefixes or member identification numbers. Following the three-character Alpha Prefix, the member s ID card may include any combination of alpha-numeric characters (letters or numbers) for a maximum total length of 17 characters. Provider may even see cards with fewer than 17 characters. Update the billing staff with this key information. CPT Code 99070: For CPT Code [supplies and materials (except spectacles) provided by the physician over and above those usually included with the office visit or other services rendered], always include a description to avoid delays in the handling of claims. List all drugs, trays, supplies, or materials provided.

3 NOVEMBER 2005 PAGE 3 Patient Relationship Code: Arkansas Blue Cross and Blue Shield continues to receive claims with incorrect codes. Below is the approved list of Patient Relationship codes from the current UB92 manual which was updated in October, Effective September 1, 2005, any claims received with an incorrect patient relationship code will be denied. Code Title Description 18 Parent Self-explanatory 19 Grandparent Self-explanatory 20 Life Partner Patient is covered under insurance policy of his/her life partner Reserved for national assignment. Relationship Codes Effective October 16, 2003: Code Title 1 Spouse 4 Grandfather or Grandmother 5 Grandson or Granddaughter 7 Nephew or Niece 10 Foster Child 15 Ward 17 Stepson or Stepdaughter 18 Self 19 Child 20 Employee 21 Unknown 22 Handicapped Dependent 23 Sponsored Dependent 24 Dependent of a minor dependent 29 Significant Other 32 Mother 33 Father 36 Emancipated Minor 39 Organ Donor 40 Cadaver Donor 41 Injured Plaintiff 43 Child Where Insured has no Financial Responsibility 53 Life Partner G8 Other Relationship

4 PAGE 4 NOVEMBER 2005 W-9 Requests From Blue Cross and Blue Shield of Michigan: In some cases, providers are receiving claim denials directly from Blue Cross and Blue Shield of Michigan. This occurs when the Blue Cross and Blue Shield member has Medicare as their Primary coverage and the claim crosses from Medicare directly to the Michigan Plan. Michigan has a state law that requires a signed W9 form to be on file for any out-of-state provider who is paid directly. Send the information to the Arkansas Blue Cross and Blue Shield Network Development Representative for your area. The form and claim denials will be ed directly to the Michigan Plan so that claims can be finalized and payment can be made directly to you if you accepted Medicare assignment. If you should receive this type of denial: Complete a W9 form, Attach all the claim denials sent directly from Michigan with the completed W9, and National Drug Codes (NDC): National Drug Codes (NDC) are not required on a claim when billing for codes with an allowance on the fee schedule. The NDC is only required on claims when billing HCPCS Code J3490 or a HCPCS J code that is BR - By Report on the fee schedule. Phone Calls to Obtain Additional Information: A phone call must be generated to a provider s office, in some instances, to request additional information needed to handle a claim. Most of these requests are generated by the Home Plan. The current procedure is to wait 5 days for a return call. If a callback is not received within 5 days, the claim is denied for No Response. A prompt response to the phone call will prevent claims from being denied for No Response.

5 NOVEMBER 2005 PAGE 5 Unsolicited Refunds: When submitting a refund check to Arkansas Blue Cross and Blue Shield that has not been requested, the following form and a copy of the remittance advice must accompany the check to ensure the credit is applied to the correct claim, etc. TO: CLAIMS REFUND DEPARTMENT Refund Type: [ ] Arkansas Blue Cross and Blue Shield [ ] BlueCard [ ] Federal Employee Program - ABCBS [ ] BlueAdvantage Administrators of Arkansas [ ] USAble Administrators [ ] USAble Life Group Health [ ] Health Advantage [ ] Medicare Services The following information is needed in order to process your refund if a copy of the Remittance Advice is not available. (1) Reason for the refund (2) Patient Name (3) Patient ID Number (4) Claim number or BlueCard SCCF # (5) Date of Service (6) Amount (7) Provider Name (pay to) (8) Provider Number (pay to) (9) and TIN (pay to) NOTE: It is not necessary to return the original check and the entire remittance advice/ explanation of payment if just one or two patient claims are paid incorrectly. Please enclose copies of the remittance advice/explanation of payment pages with the claims paid in error highlighted and a notation of the reason for the refund.

6 PAGE 6 NOVEMBER 2005 BlueCard Remittance Advice Now Available for Viewing on AHIN: Effective September 1, 2005, the BlueCard Remittance Advice (RA) can be viewed and printed on the Advanced Health Information Network (AHIN) within two days of the electronic funds transfer (EFT). This will allow for more timely information on accounts without waiting for the paper copy to reach providers via the Postal system. The RA will remain on AHIN for 6 months for viewing and/or printing. The RA will be displayed in the same format as the paper copy. For more information regarding AHIN, visit the Arkansas Blue Cross and Blue Shield website at Air and/or Ground Ambulance Claims Filing Procedures: Claims for providers of emergency and non-emergency air and/or ground ambulance services (including medical transport entities, aero personnel, etc.) should be filed with the local plan. Bill Types for Facility Claims: Please reference the UB92 manual for the correct use of bill types for facility claims. Blue- Card is experiencing problems with bill types being utilized on facility claims that indicate the services were performed on an inpatient basis but no room and board charges are indicated. This will result in claims being rejected due to invalid bill type.

7 NOVEMBER 2005 PAGE 7 Changes Made to the BlueCard Remittance Advice: Effective October 26, 2005, several new improvements will be made to the format of the BlueCard Remittance Advice (RA). Below are some of the noted changes that have been made: 1) Relocation of Patient Account # - The patient account number has been relocated directly below the patient name for easier access to this information. 2) Patient Responsibility Line The patient responsibility line will only be printed when patient responsibility is greater then $0.00. In addition, for better clarification, includes other insurance payment amount will be stated when a primary insurance paid amount has been included in the total patient responsibility. 3) National Provider Identifier (NPI) The NPI# has been added to the provider number column. It will be printed if the NPI is present on the claim record. 4) Allowed Charges Allowed amounts have been added for display at the line level when they are provided in the claims adjudication results from the Home Plan. 5) Co-Payment The copayment amount was moved from the co-insurance column to the deductible column with a separator. 6) Remarks Code Messages The remarks code messages will only display the ones specific to the remittance advice and not an entire listing. 7) Offset Information The offset information will now include the date of service and total charge of the overpaid claim for which money is being offset. 8) Zeros (.00) - Zeros will be indicated in the payment column for each service line when applicable. Timely Response to Fax requests for Invoice, OP Reports, or Medical Records: Please make sure priority is given to fax requests for additional information to price and/ or determine benefits on claims. The sooner a response is received for these requests, the sooner the Home Plan can adjudicate the claim.

8 PAGE 8 NOVEMBER 2005 Attachments to Claims: Any attachments needed to determine correct handling of a claim (EOB, EOMB, INVOICE, etc.) should be routed directly to Arkansas Blue Cross and Blue Shield. This process should be followed even when the claim has been denied by the Home Plan. Providers should never submit claims and/or attachments directly to the Home Plan. Invoices should never be submitted with the claim. A fax request for invoices will be generated if one is needed for pricing and/or adjudication of the claim. As indicated in the above article, please give priority to fax requests to ensure timely accurate handling of the claim. Out-of-State Blue Cross and Blue Shield Members Contacting Local Plan: Members of other Blue Cross and Blue Shield plans should never be directed to contact the local plan for claims status, membership, etc. The member should always call their Home Plan for any information needed related to claims, membership, etc. Claims Denied for Timely Filing: If a claim is denied for timely filing and provider wishes to have an exception to reconsider the denial, an inquiry should be initiated through Customer Service. Once the inquiry is initiated, the customer service representative will request proof of timely filing. After the documentation is received, the member s home plan will be contacted for reconsideration. If the home plan approves the request, an adjustment will be initiated and the provider will be notified. If the request is not approved, the customer service representative will also contact the provider. Corrected Claim Submission Form: Providers may use the revised version of the Corrected Claim Submission Form (page 9) which includes a section for timely filing review. Providers need to attach the supporting documentation with the form. The Corrected Claim Submission Form is also available on our website at

9 NOVEMBER 2005 PAGE 9 P.O. Box 2181 P.O. Box 8069 P.O. Box 1460 Little Rock, AR Little Rock, AR Little Rock, AR Physician/Supplier CORRECTED BILL SUBMISSION FORM Diagnosis Code Billed Charges Procedure Code EOB Attached Interim / Final Bill TIMELY FILING REVIEW (must attach proof of timely filing) This form should not be used for submitting medical information, any medical information submitted with this form will be returned. Please complete and return this form to the address of the applicable health plan check below. See bottom of form for important information Please select (X) one: Arkansas Blue Cross and Blue Shield BlueCard Health Advantage BlueAdvantage FEP SECTION 1 - PROVIDER INFORMATION Physician/Supplier Name Provider # Date Address Telephone # City, State and Zip Code Provider Contact Name SECTION 2 - PATIENT INFORMATION Patient Name Policyholder's Name Policyholder's ID (Please include alpha prefix) Address City, State and Zip Code SECTION 3 - ORIGINAL CLAIM INFORMATION Date of Service on Original Claim Original Claim # Total Charges on Original Claim $ SCCF # SECTION 4 - CORRECTED CLAIM INFORMATION Date of Service on Corrected Claim Total Charges on Corrected Claim $ Reason for Submission Provider Contact Signature Please Note: Claims which have been rejected/returned as UNPROCESSABLE (due to claims filing, eligibility or coding issues) or for which no claim number has been assigned, are not subject to Corrected Billing. Those claims should be filed as original claims and should not have this form attached.

10 PAGE 10 NOVEMBER 2005 Helpful Questions & Answers for Claims Filing: Medicare Related vs. Medicare Advantage In Arkansas Blue Cross and Blue Shield s ongoing efforts to better service providers, we are providing information to help make filing Medicare claims easier. If you are a provider who accepts Medicare assignment and renders service to members from other Blue Plans, please note the following Questions & Answers. What are Blue Cross and/or Blue Shield Medicare-related (Medicare Primary) claims? These are claims for members whose primary insurance coverage is Medicare and secondary/supplemental coverage is provided by a Blue Cross and/or Blue Shield Plan. Examples include: Medigap (Medicare Supplemental, Medicare Complementary, and Medicare Extended) & Medicare Carve-out. How does a provider identify a member with a Medicare-related Policy? Often, members will carry more that one member identification (ID) card. The members current ID card, when Medicare is the primary payer, should be a standard Medicare card without a Blue Cross and/or Blue Shield logo. Members may also present providers with a separate member ID card with a Blue Cross and/or Blue Shield logo for Medicare secondary coverage. Where does a provider submit Blue Cross and/or Blue Shield Medicare-related claims? When Medicare is primary, submit claims to the Medicare intermediary. If the member has secondary coverage, it is essential that providers enter the correct Blue Plan name as the secondary carrier. Do not enter Arkansas Blue Cross and Blue Shield if the secondary coverage is with another Blue Plan. Verify Blue Plan name by calling Blue (2583). After receiving the Explanation of Payment (EOP) or Medicare Remittance Notice (MRN) from Medicare, review the indicators: If the indicator on the remittance shows that the claim was crossed-over, Medicare has forwarded the claim on behalf of the provider to the appropriate Blue Plan. The claim is in process. Providers can make claims status inquiries through Arkansas Blue Cross and Blue Shield. If there is not a crossover indicator on the remittance, submit the claim to Arkansas Blue Cross and Blue Shield with the MRN. For claim status inquiries, contact Arkansas Blue Cross and Blue Shield. Do not submit Medicare-related claims to the local Blue Plan before receiving a MRN from the Medicare intermediary. Duplicate claims submissions can delay claim processing and create administrative inefficiencies for providers and the insurance plan. What are Blue Cross and/or Blue Shield Medicare Advantage claims? Medicare + Choice and Medicare Risk claims are now referred to as Medicare Advantage. Several Blue Plans have been authorized by the Centers for Medicare and Medicaid Services (CMS) to offer these products in the form of HMO s and PPO s. The Blue Plan is the primary payer for Medicare Advantage claims. How does a provider identify a member with a Medicare-Advantage Policy? Members who enroll in a Medicare Advantage product agree to obtain most services through network providers, but may seek service in another state. Ask for the member ID card. Members will not have a standard Medicare card. However, a Blue Cross and/or Blue Shield logo will be visible on the member ID card.

11 NOVEMBER 2005 PAGE 11 Verify eligibility by contacting Blue (2583) and providing the alpha prefix. Be sure to ask if Medicare Advantage benefits apply. If providers experience difficulty obtaining member eligibility information, please record the alpha prefix and report it to Blue Card Customer Service at Where do providers submit out-of-state Medicare Advantage claims? Submit claims to the local Blue Plan. Do not bill Medicare directly for any services rendered to a Medicare Advantage member. Payment is made directly by a Blue Plan. Based upon CMS regulations, if a provider accepts Medicare assignment and renders service to Medicare Advantage members from other Blue Plans, the provider will be reimbursed the equivalent of the current Medicare allowable amount for all covered services. This amount may be less than the charge amount. CMS regulations state that the Medicare allowable amount is considered payment in full. Other than the applicable member cost sharing amounts, reimbursement is made directly by the Blue Plan. Providers may collect only the applicable cost sharing (i.e. co-payment) amounts from the member at the time of service, and may not otherwise charge or balance bill the member. Claim status inquiries can be made through Arkansas Blue Cross and Blue Shield. Currently, there is only a small volume of Medicare Advantage members. Please review the remittance to note references to CMS requirements for Medicare allowable amount, member s payment responsibility, and balance billing limitations. Who does a provider contact for questions? If a provider has any questions, they should contact the BlueCard Customer Service at

12 PAGE 12 NOVEMBER 2005 Arkansas Blue Cross and Blue Shield P. O. Box 2181 Little Rock, AR Presorted Standard U.S. Postage Paid Little Rock, AR Permit #1913