Tertiary Claim Rejections – Electronic Submitter Update

October 22, 2012

In a previous notification, we alerted you that Blue Cross and Blue Shield of Oklahoma (BCBSOK) was incorrectly rejecting tertiary claims for balancing issues. We also reported that the issue had been resolved and that BCBSOK would resume accepting tertiary claims as of Aug. 20, 2012.

While tertiary claims are now being accepted, we have determined that claims continue to be rejected when the Payer IDs for the primary and secondary payer are identical. Tertiary claims are also being rejected when the paid and adjusted amount(s) do not balance at the service line.

To help prevent future rejections, please confirm the following before transmitting a tertiary claim:

  • The Paid Amount and the Adjusted Amount(s) at the service line (Loop 2430) balance to the service line Monetary Amount (Loop 2400), which then rolls up to the Total Claim Charge Amount (Loop 2300, CLM02);
  • The correct (and valid) Payer ID is included in Loop 2330B, NM109; and
  • Valid Payer IDs are present in Loop 2430, SVD01, the primary, secondary and tertiary Coordination of Benefits (COB) loops of the claim.

If you use a billing service or clearinghouse, please make sure they are aware of this information. If you encounter balancing issues on your claims, please contact your practice management system vendor for assistance.