New requirements to take effect for facilities submitting BCBSM, FEP^® adjustment claims

We’re working to fully automate the process facilities use to submit Blue Cross Blue Shield of Michigan and Federal Employee Program adjustment claims by early 2015.

Our goal is to:

• Improve the accuracy of 835 remittances.
• Speed up claims processing time.
• Reduce the time spent on manual adjustments.
• Reduce facilities’ account receivables.

To prepare for the transition, new requirements are expected in November 2014 for:

• Late charges (facility type of bill XX5)
• Replacement claims (facility type of bill XX7)
• Void and cancel claims (facility type of bill XX8)

When billing late charge TOB XX5 claims, you should only report the charges for the additional services that weren’t on the original claim. If you’re replacing the original claim, all charges should be reported with TOB XX7, whether it was originally paid, rejected or applied to member cost sharing.

All TOB XX7 and XX8 claims will require the 14- or 17-digit Internal Control Number of the original claim. ICNs are reported with a qualifier of F8 in the REF segment of Loop 2300 in 837 claim transactions.
 
Claims submitted without the 14- or 17-digit ICN will be rejected by the Electronic Data Interchange Department using a 277CA report or transaction. If the claim was submitted with an ICN, it may still reject on a voucher if the processing system is unable to locate a match.

For questions regarding electronic 837 transactions, contact the EDI Helpdesk at 1-800-542-0945. For assistance with billing guidelines, contact your BCBSM provider consultant.