Private Payer Roundup, October 2016

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.

If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Visit www.texmed.org/getpaid for more resources and information. 

BCBSTX

Change to Medicare Advantage plan claims: Effective Jan. 1, 2017, changes in Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) will affect claims submissions for Blue Cross and Blue Shield of Texas (BCBSTX) Medicare Advantage (MA) plans. 

  • The payer ID for these Blue Cross plans will change to 66006 for claims submitted on and after Jan. 1, 2017. If you aren’t registered with Availity and Passport/NEBO (ecare online), contact your clearinghouse to confirm the new payer ID, as other clearinghouses may assign their own unique number. Note that the Blue Cross MA member ID cards in Texas will contain the following member ID number alpha prefixes: ZGD for PPO plans, and ZGJ for HMO plans. Use new payer ID 66006 to submit electronic claims for any MA member — you will no longer use the commercial payer IDs for these claims. Wrongly submitted claims will be denied.
  • Payment cycles change from weekly to daily. Blue Cross MA will make daily payments.
  • The paper claim mailbox address for nondelegated providers will change to Blue Cross Medicare Advantage, PO Box 3686, Scranton, PA 18505. The fax number will be (855) 674-9192.
  • Electronic remittance advice (835 ERA) files will be distributed to the address associated with the billing provider’s tax ID, rather than to multiple locations.

In addition, watch for coming information about a new format for electronic funds transfers and paper checks and a new process for claims overpayment recovery.

Source: BCBSTX

United HealthCare

New National Drug Code requirement policy: Effective for claims with a date of service on or after Jan. 1, 2017, claims submitted for drug-related codes for UnitedHealthcare (UHC) commercial and Medicare Advantage members must include the National Drug Code (NDC) number, quantity, and unit of measure along with the corresponding HCPCS and CPT codes and units administered for each code. Otherwise, UHC will deny the claim and direct you through a provider remittance advice to resubmit the claim with the NDC information.  

Source: UHC Network Bulletin, October 2016 

UPDATE! Laboratory benefit pilot on hold: UHC has put on hold an expansion of its Laboratory Benefit Management Program pilot that was to have extended to fully insured commercial plan patients in Texas effective March 1, 2017. TMA received confirmation of UHC's decision in January 2017, after meeting with UHC the previous December. 

The pilot program began and is still running in Florida in collaboration with Beacon Laboratory Benefit Solutions, Inc., a subsidiary of LabCorp, which specializes in laboratory management services. All outpatient lab services for patients who are part of the pilot program are subject to new requirements, including advance notification and medical policies. Ordering and rendering physicians use BeaconLBS Physician Decision Support (PDS) technology for lab services, which UHC made available Jan. 1 to physicians in its Texas networks.

These physicians continue to have access to the PDS tool and are encouraged to use it when ordering Decision Support Tests but are not required to. UHC says the PDS tool technology makes it easier to choose the right tests and labs for patients based on evidence-based guidelines and industry best practices. To register, visit BeaconLBS.com and select Physician Login. 

The Laboratory Benefit Management Program is expected to go into effect in Texas at an as yet undetermined date. UHC physicians will receive a 90-day advance notice.

 Updated Jan. 23, 2017

TMA Practice E-Tips main page

Last Updated On

April 19, 2018

Originally Published On

October 28, 2016