Blue Cross OGB-dedicated Customer Service:

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1 Blue Cross OGB-dedicated Customer Service: Frequently Asked uestions Blue Cross and Blue Shield of Louisiana administers benefits for the Office of Group Benefits (OGB) for their PPO, HMO and Consumer Driven Health Plan (CDHP) benefit plans. These products are self-insured plans that utilize our extensive OGB Preferred Care 2013 network of doctors, hospitals and other medical care providers as well as Blue providers nationwide. PPO Benefit Plan HMO Benefit Plan Consumer Driven Health Utilizes the OGB Preferred Care 2013 network of providers and is available to active OGB employees, retirees with Medicare and nonmedicare retirees. Utilizes our OGB Preferred Care 2013 network of providers even though this is an HMO product. This plan is available to active OGB employees, retirees with Medicare and nonmedicare retirees. Utilizes our OGB Preferred Care 2013 network of providers and is available to active OGB employees. OGB employees enrolled on this plan have a high-deductible and may open a health savings account (HSA). Who is OGB? The Office of Group Benefits (OGB) is a 40-year old state agency within the office of the governor. OGB provides insurance benefits to state employees, retirees and their dependents. OGB members include employees who work in state agencies, institutions of higher education, local school boards and certain political subdivisions. When will Blue Cross begin administering benefits for OGB members? Blue Cross and Blue Shield of Louisiana is the current healthcare administrator for the OGB HMO Benefit Plan. Under a new contract with OGB, Blue Cross will continue to administer the HMO Benefit Plan and will also administer the OGB PPO and Consumer Driven Health Plan (HSA compatible plan referred to as CDHP) benefits. The new contract with OGB is effective January 1, What Blue Cross provider networks are used for the OGB benefit plans? OGB s HMO, PPO and CDHP benefit plans utilize our statewide Preferred Care PPO provider network. The OGB Preferred Care 2013 online directory network selection should be used when searching for in-network providers of OGB members for the PPO, HMO and CDHP benefit plans. OGB members will also have access to Blue providers nationwide. Visit to view our online provider directory or visit to find Blue providers nationwide. What do I do if a OGB member asks me if I participate in their network? If an OGB members ask you if you participate in their network, please confirm they are an OGB PPO, HMO or CDHP benefit plan member. If so, and you are a Blue Cross Preferred Care PPO network provider, you are in-network for that member. Please refer members to Blue Cross OGB-dedicated customer service line at , if they have questions you can t answer. How can I find other OGB participating providers for my patient? You may use our online provider directories available at to locate network providers for OGB members. From the drop-down box, choose the OGB Preferred Care 2013 network selection. 18NW /12 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company 1

2 Plan with HSA option Beginning January 1, 2013, what OGB claims will Blue Cross process? On January 1, 2013, Blue Cross will begin processing/paying: OGB PPO claims (regardless of the date of service) Blue Cross will process both claims with a date of service on and after January 1, 2013, as well as run-in* claims. OGB LaCHIP Affordable Plan run-in* claims ONLY Blue Cross will NOT process OGB LaCHIP Affordable Plan claims with a date of service ON OR AFTER January 1, 2013, as we are not the healthcare administrator for these benefits. The Bayou Health Program vendor will be the carrier for OGB LaCHIP Affordable Plan members effective January 1, OGB CDHP claims with a date of service ON OR AFTER January 1, 2013 OGB CDHP run-in* claims should NOT be sent to Blue Cross. These claims will continue to be processed by the former healthcare administrator. We are only able to process CDHP claims with a date of service on and after January 1, OGB HMO claims (regardless of date of service) Since July 1, 2010, OGB HMO claims have been and will continue to be processed by Blue Cross. * Run-in claims refers to claims with a date of service PRIOR TO January 1, Where do I file OGB claims? Providers may submit claims electronically or hardcopy. We offer two options for when filing electronically; through our ilinkblue Provider Suite or through your clearinghouse. More on our electronic services is available online at >I m a Provider >Electronic Services. Hardcopy Claims: Beginning December 15, 2012, providers who file hardcopy claims to OGB may begin sending their OGB PPO cand OGB LaCHIP Affordable Plan run-in claims directly to Blue Cross at BCBSLA, P.O. Box 98029, Baton Rouge, LA Electronic Claims: Providers who file electronically to OGB should continue sending run-in claims to their clearinghouses. We are working with the OGB clearinghouses to ensure OGB PPO and OGB LaCHIP Affordable Plan run-in claims are routed to Blue Cross on January 1, Clearinghouses may communicate special instructions directly with providers on best practices for handling claims during the two week transition period. Providers should follow the instructions they receive. Note: There is no change in the claim filing process for OGB HMO members. Since July 1, 2010, OGB HMO claims have been and will continue to be processed by Blue Cross. Will the transition to Blue Cross cause delays in claims processing? You may notice a short delay in claims processing times on OGB PPO and OGB LaCHIP Affordable Plan claims submitted between December 15 and December 31, Blue Cross and OGB are working closely together to ensure that your claims are processed and paid in a timely manner as OGB transitions to Blue Cross on January 1, To ensure that all pending claims in the OGB claims processing system are processed timely, OGB has a claims processing cut-off date of December 14, Claims (both hardcopy and electronic) received by OGB after December 14, 2012, will be forward to Blue Cross for processing. Blue Cross will begin processing/paying these claims on January 1, NW /12 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company 2

3 How are Medicare cross-over claims processed during the transition to Blue Cross? Beginning December 15, 2012, Group Health Inc. (GHI) will discontinue the Medicare electronic cross-over process to OGB for their PPO members. Then, on January 1, 2013, electronic Medicare cross-overs will resume directly to Blue Cross. When reviewing your Medicare cross-over claims for OGB PPO members with a date of service prior to January 1, 2013, please pay careful attention to the Medicare cross-over indicator. If the claim did not cross-over electronically, you may send these claims hardcopy to BCBSLA, P.O. Box 98029, Baton Rouge, LA Will Blue Cross issue new ID cards for OGB members? Yes. Blue Cross member ID cards are being issued to OGB s PPO, HMO and CDHP members to use for dates of service on or after January 1, These Blue Cross member ID cards should NOT be used for dates of service PRIOR to January 1, We will NOT issue member ID cards for OGB s LaCHIP Affordable Plan members as we are not the healthcare administrator for this benefit plan. The Bayou Health Program vendor will assume the administration of LaCHIP Affordable Plan, effective January 1, What member ID numbers should be filed on claims? OGB PPO and OGB LaCHIP Affordable Plan claims for dates of service PRIOR to January 1, 2013, should be submitted using the subscriber s social security number (SSN). OGB PPO and CDHP claims with a date of service ON OR AFTER January 1, 2013, should be submitted using the member ID number found on the Blue Cross issued member ID card. OGB HMO Claims for any date of service should be submitted using the member ID number found on the Blue Cross issued ID card. For samples of Blue Cross issued member ID cards for OGB, see the OGB Speed Guide or the Professional Provider Office Manual, both available at >I m a provider >Education on Demand. Will I receive separate payment registers (remittance advices) for OGB members? Today, you already receive a separate payment register when you provide services for an OGB HMO member. Beginning January 1, 2013, you will also receive separate payment registers when you provide services for OGB PPO and CDHP members. Additionally, you will receive separate payment registers when you file any run-in claims for OGB PPO and/ or OGB LaCHIP Affordable Plan services that were performed prior to January 1, When viewing your payment registers using ilinkblue, separate links will be available when claims are processed for OGB members. Furthermore, this also means that you will receive a separate electronic funds transfer transaction for each separate OGB payment register. Separate payment registers are provided at the request of OGB for clarity in the accounting process. What services require an authorization for OGB members? Detailed lists of services that require authorization based on benefit plan are available in our OGB speed guide as well as our provider manuals. Failure to obtain prior authorization when required, will result in denial of payment for services. 18NW /12 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company 3

4 When Blue Cross authorizes care, is the authorization an automatic guarantee of payment for services rendered? No. Authorization of services is not a guarantee of payment. Payment depends on a number of factors including member eligibility, provider contract status, and benefit limits at the time care is rendered. Do all inpatient admissions require an authorization? No. Maternity admissions to in-network facilities (or out-of-network facilities if the member has out-ofnetwork benefits) do not require authorization if the inpatient stay is 48 hours or less for vaginal delivery and 96 hours or less for Cesarean section delivery. Inpatient services for newborn well-baby services are included in the mother s stay. However, authorization is required for inpatient sick-baby services. All other inpatient admissions, including those for transplants, behavioral health, etc., do require an authorization. What will happen to the existing medical and authorization information for my patient? There will be a full continuity of care transition in place for OGB members. Blue Cross is working with the previous OGB carrier to obtain information on any possible continuity of care situations and pending authorizations for OGB members. How will Blue Cross handle continuity of care? Blue Cross is working with the previous OGB carriers to obtain information on any possible continuity of care situations and pending authorizations for OGB PPO and CDHP Plan members. Should I split inpatient facility claims for patient stays that extend past December 31, 2012? Medical Claims For OGB PPO and OGB LaCHIP Affordable Plan inpatient stays that extend past December 31, 2012 (have an admission date prior to and a discharge date after January 1, 2013), DO NOT split the patient s inpatient facility claim. Please file the entire facility claim directly to Blue Cross for processing. Note: Blue Cross does not process OGB LaCHIP Affordable Plan claims with a date of service on or after January 1, 2013, except when it s an inpatient split claim with an admission date prior to January 1, For OGB CDHP inpatient stays that extend past December 31, 2012, please split the facility claim and file ONLY dates of service on and after January 1, 2013, to Blue Cross as a hardcopy claim. The dates of service prior to January 1, 2013, for the facility claim should be filed to the former healthcare carrier for processing. Behavioral Health Claims For OGB PPO and OGB HMO behavioral health residential treatment center and partial hospitalization claims that extend past December 31, 2012, please split the claim and file ONLY dates of service on and after January 1, 2013, to Blue Cross as a hardcopy claim. The dates of service prior to January 1, 2013, for the facility claim should be filed directly to ValueOptions, the former behavioral health carrier. You may reach ValueOptions at or go to For OGB CDHP behavioral health inpatient stay, residential treatment center and partial hospitalization claims that extend past December 31, 2012, please split the facility claim and file ONLY dates of service on and after January 1, 2013, to Blue Cross as a hardcopy claim. The dates of service prior to January 1, 2013, for the facility claim should be filed to the former healthcare carrier for processing. 18NW /12 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company 4

5 Who handles Care Management for OGB members? Care Management programs for OGB members are administered by Blue Cross and Blue Shield of Louisiana. Disease Management OGB members diagnosed with one or more of these conditions (diabetes, coronary artery disease, heart failure, asthma or chronic obstructive pulmonary disease) are eligible to participate in Blue Cross disease management program (In Health: Blue Health Services). This program provides access to a personal nurse or healthcare professional who can along with the member s physician and other healthcare professionals help them address their current health status as well as their long term health. Case Management Physicians may refer patients for our case management program (In Health: Blue Touch), which is designed to help members with complex health issues through education and coordination of services and resources to reduce barriers for good health outcomes. More information about our Case and Care Management programs is available online at >I m a Provider >Care Management. Who is the behavioral health carrier for OGB members? Blue Cross and Blue Shield of Louisiana will be the carrier of behavioral health services for OGB members. This means OGB PPO, HMO and CDHP members will use Blue Cross behavioral health network providers (not Magellan network providers) for behavioral health services. We will not pay more than one visit (per benefit period) if the OGB member uses a medical provider for a behavioral health diagnosis. Blue Cross behavioral health providers may use ilinkblue or contact Blue Cross OGB-dedicated customer service line for claims and benefits services for OGB members. Authorizations ONLY for behavioral health services for OGB members, are handled by Magellan Health Services, Inc. ( ). Who is the pharmacy carrier for OGB members? There are two different pharmacy carriers for OGB members, depending on their benefit plan. OGB members who choose the PPO or HMO benefit plan will have pharmacy benefits through Catamaran (formerly Catalyst Rx). OGB members who choose the Consumer Driven benefit plan will have pharmacy benefits through Express Scripts, Inc. (ESI). What is the timely filing limit for claims for OGB members? For claims with a date of service on and after January 1, 2013, they must be filed within 12 months of the date of services. Claims received after 12 months will be denied for timely filing and the OGB member and Blue Cross should be held harmless. Claims reviews including refunds and recoupments must be requested within 18 months of the receipt date of the original claim. What is the appeals process for claims for OGB members? OGB member appeals will be handled by Blue Cross and Blue Shield of Louisiana. This includes claims for dates of service prior to January 1, 2013, that were processed by the prior OGB carrier. Appeals should be mailed to BCBSLA - Appeals and Grievance Unit, P. O. Box 98045, Baton Rouge, LA Where can I get more information about provider requirements for OGB members? More information on OGB is included in our office manuals and OGB speed guide, available online at >I m a Provider >Education on Demand. Who do I call if I have questions about OGB members? If you have questions that are not covered in our provider office manuals or in the OGB speed guide. You may also call Blue Cross OGB-dedicated Customer Service NW /12 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company 5