Vendor Meetings
Blue Cross Blue Shield of Kansas EDI Services
Vendor Call Minutes
September 20, 2007
General Announcements
- On September 5, 2007, CMS notified BCBSKS that Wisconsin Physicians Services (WPS) was selected as the Medicare Administrative Contractor (MAC) for Jurisdiction 5. This will mean that Medicare Part A and Medicare Part B for Kansas, Nebraska and NW Missouri will be transitioned to WPS on March 1, 2008. Formal Medicare notification is posted at http://www.wheatlandsadmin.com/WPSJ5Contractor.htm.
- In preparation for this move we want to encourage all EDI clients to begin splitting Medicare claims into separate batches from all other payer claims.
- More information on Medicare Reform can be found at http://www.cms.hhs.gov/MedicareContractingReform/01_Overview.asp#TopOfPage.
NPI Information
- BCBSKS:
- 837 Transactions (Claims) – Accepts NPI only, Dual Use, or Legacy only. Trading partners wanting to send NPI only must notify BCBSKS first.
- 835 Transactions (Remits) – Trading partners will receive the same provider numbers submitted on the claims.
- BCBSKC:
- 837 Transactions (Claims) – Accepts NPI only, Dual Use, or Legacy only.
- 835 Transactions (Remits) – Trading partners will receive both legacy and NPI on all 835 transactions, if the NPI has been reported to BCBSKC.
- Medicare A:
- 837 Transactions (Claims) – Accepts NPI only, Dual Use, or Legacy only.
- Medicare B:
- 837 Transactions (Claims) – Accepts NPI only, Dual Use, or Legacy only.
- Effective August 29, 2007, Wheatlands Administrative Services Part B, began editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. The percentage of claim rejections for these edits is still very high. Providers submitting claims to Medicare should be reviewing all reports available to them and validate all claims submitted are being accepted.
- M340 (2010AA Billing Provider NPI/PIN Validation Edit)
- M341 (2010AB Pay To Provider NPI/PIN Validation Edit)
- M343 (2310B Rendering Provider NPI/PIN Validation Edit)
- M347 (2420A Rendering Provider NPI/PIN Validation Edit)
- M379 (2010AA Billing Provider NPI/TIN Validation Edit)
- M380 (2010AB Pay To Provider NPI/TIN Validation Edit)
- M381 (2310B Rendering Provider NPI/TIN Validation Edit)
- M382 (2420A Rendering Provider NPI/TIN Validation Edit)
- EDI is available to assist you and your clients with NPI. Please contact us at 1.800.472.6481
- BCBSKS, and Medicare A and B are urging the submission of NPI only.
- The NPI Registry is now available and can be found at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.
Trading Partner Education
- ASK and BCBSKS are continuing to contact providers regarding errors with NPI. This is being done to ensure a smooth transition to NPI. Documentation of all calls will be maintained to assist with any questions regarding the calls.
- Warning and Rejection messages are reported back to the trading partner on several reports. It is important that all reports are reviewed for Warnings and Rejections. Warnings will not cause the claims to reject; however, they should be corrected as soon as possible to avoid rejections in the future. The EDI Help Desk will be glad to help with any questions regarding the edits. Warning and rejection edits can be found on the Claims Confirmation Report, MCS EDI Edit Reports (IXE extension), and the EDI Midwest Reports.
System Updates
- The next routine system deployment is scheduled for September 30, 2007.
All Payer Information
- Medicare – COB (automatic claim crossovers)
CR 5601 and 5662 and MedLearn Matters address auto crossovers. Currently nothing will need to change with the way providers submit claims to Medicare unless they are submitting claims for a plan that is a claim based processor. If the insurance plan is a claim based crossover insurance payer, the five digit payer id number will begin with the number 5 and must be included on the primary claim submission to Medicare in order for the claim to auto crossover. If the payer id is not included the claim will not auto cross. This begins October 1, 2007. CMS encourages making every effort to educate providers to be accountable. Providers should know the type of secondary insurance (BCBSKS, Medigap, or other supplemental) patients carry and be able to identify payer id numbers. Last week Medicare sent notification (http://www.cms.hhs.gov/COBAgreement/Downloads/Contacts.pdf) that identified current eligibility based insurance plans. Medicare will continue to auto cross eligibility based COB trading partners claims. CMS will also publish and notify through email notifier any updates concerning COB at the web site.
Upcoming events:
- EDI Workshops
October 9, 2007 – Independence, KS
October 16, 2007 – Wichita, KS
- Conventions
October 6, 2007 – KOA – Wichita, KS
October 26, 2007 – KCA – Topeka, KS
We want to encourage you and your clients to share suggestions and ideas on how EDI Services can provide better assistance. Please send emails to askedi@ask-edi.com or MedicareEDI@wheatlandsadmin.com with suggestions.
The next regularly scheduled conference call is October 18, 2007.
Phone Number: 1-877-326-2337 – Pass code 2102557
Web Addresses:
www.wheatlandsadmin.com
www.ask-edi.com
www.bcbsks.com
www.bcbskc.com
Email Address:
askedi@ask-edi.com
MedicareEDI@wheatlandsadmin.com
Phone: 800-472-6481
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