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September 2015

New automated system strives to speed up processing time of adjusted facility claims

Blue Cross Blue Shield of Michigan is establishing an automated process to improve the claim processing time and accuracy of the electronic remittance you receive for adjusted facility claims. This initiative is expected to launch Sept. 21, 2015, and will include Federal Employee Program® facility claims.

To help us improve the processing time for corrected facility claims and to avoid front-end rejections, follow these steps when submitting electronic 837 claim transactions:

  1. Include the proper claim frequency code in the 837 file to indicate that the claim is an adjustment of a previously approved or denied claim. Enter one of these claim frequency codes in the CLM05-3 segment of loop 2300:

Type of claim

Claim frequency code

14- or 17-character internal claim number of the original claim

Replacement of prior claim

7

Required

Voided or canceled claim

8

Required

Late charges claim

5

Not required

  1. In the REF*F8 segment of loop 2300, include the 14- or 17-character internal claim number of the original claim.

    Note: Be sure to submit the correct internal claim number of the original claim with your replacement claim. Otherwise, the processing system will reject the replacement claim if it’s is unable to locate the matching claim.

We’re expecting to implement an automated process for professional claims in the third quarter of 2016.

If you have questions about submitting an 837 for an adjusted claim, contact the Electronic Data Interchange help desk at 1-800-542-0945. For assistance with reporting this information using your practice management system, contact your software vendor or clearinghouse.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.