Blue cross timely filing8/5/2023 ![]() At that time, please discontinue submitting paper claims. When this notification has occurred, change the indicator on your claims from ( T)est to ( P)roduction and begin submitting live electronic claims. We'll notify you in writing or by telephone when you have successfully completed the test phase. An EDI representative will review the test claims with you or your vendor.We review test claims for accuracy, but we don't process them for payment. Continue to submit paper claims until you are told to stop. Your software vendor can help you set up your computer to accommodate Premera's billing requirements.They will send you the following documents: You will need special software to send insurance claims electronically. If you already have a computer system, notify your software vendor of your desire to convert to electronic claims.If you are interested in purchasing a new computer system, ask us for a list of vendors that submit claims to us in the HIPAA standard ANSI 837 format.To help you move from paper to electronic claims, follow these steps: Your office staff can then post this remittance manually or electronically (if your software has electronic posting capability). Remittance is available online-just let us know. Detailed claim acceptance and rejection reporting.Validation to ensure that they are HIPAA-compliant.Dimensions (HeritagePlus, HeritageSelect, or Global).National Account Service Company (NASCO).Premera Blue Cross Blue Shield of Alaska Participating (Traditional/Indemnity) and Preferred/BestCare (PPO).If you submit your claims electronically, you may receive electronic remittance for the following: There is no charge to healthcare providers who submit electronic claims directly to us. Invalid claims are reported back to the provider with rejection details. Our electronic claims process electronically separates and routes only valid claims for processing. Please refer to your electronic billing manual for specific formatting for electronic claims. The National Uniform Claim Committee (NUCC) has developed a 1500 Reference Instruction Manual detailing how to complete the claim form to help nationally standardize how the form is completed. Note that some processing systems may have a limitation regarding the number of characters recognized. Your account number can be included in box 26 (Patient's Account Number) of the CMS-1500 form whether you submit electronically or on paper. To make tracking patient reimbursement easier, we can include these account numbers on our payment vouchers. Many offices assign their own account numbers to patients. Patient account numbers assigned by your office This includes claims for outpatient services and services performed by a hospital-based physician or other qualified healthcare provider. If you are a clinic or hospital-based physician or other qualified healthcare provider, use a CMS-1500 (02-12) form for claims for professional services and supplies related to: Incorrect member number: Provider billing used the member's social security number (SSN) instead of the non-SSN member identification number on the member's card.The onset date was missing from box 14 in the CMS-1500 claim form. ![]() Codes: The person submitting the claim used invalid CPT/HCPCS, modifiers, or diagnosis codes.PAs: Supervising physician's name is missing for PA ( Note: A PA does not need to bill with a supervising physician if he/she is a Surgical Assistant and has completed the paperwork to be set up independently in our payment systems).Advanced registered nurse practitioner: Supervising physician's name is missing for non-credentialed and/or not contracted ARNP.Home IV drugs: NDC number and quantity is missing.Anesthesia time is billed in units to represent minutes and additional base units for the code. Anesthesia: The hours/minutes for anesthesia claims are not included.The claim rejects if records are not attached that support the change. Rebilling: Records are missing when rebilling with a different diagnosis or other change.Information doesn't match: Physician/provider information doesn't exactly match what is in our payment system.Here are common reasons why claims suspend or reject: If claims are submitted after this time frame, they will most likely be denied due to timely filing and thus, not paid.Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out. The following table outlines each payers time limit to submit claims and corrected claims.
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