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Government Programs: Electronic Claim-related Process Improvements and Reminders

September 3, 2018

The notice applies to providers submitting Blue Cross and Blue Shield of Oklahoma (BCBSOK) government programs claims for Blue Cross Medicare Advantage (HMO)SM and Blue Cross Medicare Advantage (PPO)SM members only.

Providers submitting electronic government programs claims for Medicare Advantage members may have experienced membership validation claim rejections and duplicate claim rejections. The duplicate claim rejections occurred when Professional and Institutional electronic claims (837P and 837I transactions) were resubmitted within 90 days of a previously submitted claim that included the exact data for the same patient and date(s) of service.

Effective September 15, 2018, BCBSOK will implement claim processing changes to eliminate the above-referenced claim rejection issues. With this implementation, some providers may encounter new claim submission edits for Professional and Institutional claims (837P and 837I transactions), which will help improve accuracy and timeliness in processing. Claims with insufficient or invalid data will reject upon submission, allowing providers to correct the error(s) and resubmit the claim immediately, thereby avoiding claim processing delays. Additionally, for electronic claims submitted by 5 p.m. (CT), submitters should receive their payer acknowledgement response files on the same day.

These changes will not impact electronic fund transfer (835 EFT) or electronic remittance advice (835 ERA) transactions.

As a reminder, Medicare Advantage electronic claims that are submitted via the Availity® Provider Portal must be submitted using Payer ID 66006. For claims that are submitted using direct data entry through the Availity Portal, providers should select the drop-down payer option of “Blue Cross Medicare Advantage” for Medicare Advantage claims.

Providers who are not registered with Availity should contact their clearinghouses to confirm the appropriate Payer IDs to be used when submitting government programs claims, as other clearinghouses may assign their own unique numbers.

If you have questions regarding an electronic claim rejection message, contact your practice management system software vendor, billing service or clearinghouse for assistance. For additional information on electronic options, refer to the Electronic Commerce page located in the Claims & Eligibility section of our website at bcbsok.com/provider.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.