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December 2014
Reminder: BCBSM Medicare Advantage PPO processing system for pre-2013 claims to shut down
Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO claim processing system for claims with dates of service before 2013 will shut down Dec. 31, 2014.
To avoid any claims processing problems, be sure to submit any adjustment requests for claims prior to 2013 as soon as possible, and no later than Dec. 29, 2014.
Also, if you discover an overpayment and the date of service is before Dec. 31, 2012, send a check with the applicable member and claims information to:
Senior Business Division
Blue Cross Blue Shield of Michigan
P.O. Box 441187
Detroit, MI 48244-1187
HDI audits
To avoid any claims processing problems associated with the HDI audits for claims with dates of service prior to 2013, be sure to submit any adjustment request(s) to your provider consultant as soon as possible.
As of Jan. 1, 2015, any HDI and/or PGBA outstanding claim issue (e.g., outpatient re-bills, Administrative Law Judge decisions) must be forwarded to your provider consultant for resolution outside the claims system. To expedite those inquiries, please provide the following information for research:
- Patient name
- Patient contract number
- Patient medical record number
- Claim number
- Date of service
- ALJ appeal number
- Amount
BCBSM will follow up on all HDI inquiries.
EDI
Electronic claims with dates of service prior to 2013 will receive the following front end edits from BCBSM EDI:
Professional
P285 A3 718 DATE OF SERVICE BEYOND TIMELY FILING LIMIT
P617 A3 718 ADJ CLAIM IS BEYOND TIMELY FILING, CONTACT MA PROV INQ
Institutional
F243 A3 718 STATEMENT DATE BEYOND TIMELY FILING LIMIT
F718 A3 718 ADJ CLAIM IS BEYOND TIMELY FILING, CONTACT MA PROV INQ
Edits will be returned in our 277CA reports and transactions. If you have questions regarding the edits, contact the eBIG/EDI Business help desk at 1-800-542-0945.
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