March 6, 2020
Starting April 1, 2020, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will begin implementing enhancements to our electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions).* This enhancement will allow claim edits to be applied to claims during the pre-adjudication process to help increase efficiencies.
Currently, electronic claim submissions are accepted into the BCBSOK adjudication system for processing and then deny when needed data elements are not included. Providers submitting claims electronically on or after April 1, 2020, may see new edit messages on the response files from their practice management system or clearinghouse vendor(s) before the claim is adjudicated. These responses will specify if additional data elements are required. If you receive claim rejections, the affected claims must be corrected and resubmitted with the needed information as specified in the rejection message. By rejecting the claim submission during the pre-adjudication process, you will have the ability to identify errors earlier in the process and make necessary corrections more quickly.
If you have questions regarding an electronic claim rejection message, contact your practice management/hospital information system software vendor, billing service or clearinghouse for assistance.
*These new validation edits do not apply to Medicare Advantage electronic claim submissions.