BlueCard^® connection: Why don’t I always see my BlueCard replacement claim on web-DENIS?

When we receive a replacement claim from you for a BlueCard member, your replacement claim appears on web-DENIS as a pending adjustment to your original claim and not under a new ICN. This occurs because of an automated process Blue Cross Blue Shield of Michigan established in September 2015 to improve the processing of replacement claims.

Please note: Replacement claims can no longer be viewed in web-DENIS as a unique ICN but can be viewed as an adjustment to your original claim.

Home plans may deny our request to process replacement claims because they require additional information. If the BlueCard claims department has the information required or if the claim was denied in error, the department will automatically work with the home plan to reprocess your claim. Once finalized, your replacement claim will be posted on web-DENIS as an adjustment to your original claim.

If your replacement claim wasn’t billed correctly or the plan maintains its denial, you’ll receive written communication with the details. You may contact Provider Inquiry for questions on the claim and for assistance with details of the claim denial.

Here are some helpful tips in preventing a BlueCard replacement claim from denying:

• Ensure your original claim is finalized before sending a replacement claim.
• Ensure all patient demographics on the replacement claim are the same as reported on the voucher of the finalized original claim.
• Include the 14-digit ICN from the original claim. (The ICN can be obtained from the original claim information on web-DENIS.)
• Include all the charges for services you’re billing on the claim and not just your changes. The replacement claim replaces your original claim in its entirety.

Blue Cross Blue Shield of Michigan and other Blue plans are addressing this automation process with the Blue Cross and Blue Shield Association. Changes that may occur as result of these discussions will be communicated in a future Record article.

For more information on the BlueCard program, including links and articles on online tools, reference the BlueCard chapter of the online provider manuals.

If you’re experiencing issues with the information provided in the BlueCard chapter of the online manual — or if you’d like more information on a particular topic — contact your provider consultant.

Want to suggest a topic to be covered in this series? Send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.