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DPAP 202

Resubmission, Reprocessed and Corrected Claims


Provider Administrative Policy

Section
Claims Submission
Policy Date
January 2012
Status/Date
Revised/November 2014
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).

 


Policy

Resubmission, Reprocessed and Corrected Claims

If you have a question about payment on a claim for date of service on or after January 1, 2012:

  1. Visit the secure provider portal on the Blue Cross of Idaho website, bcidaho.com, select Dental Eligibility and Claims and review the member benefits document.
  2. To determine how we processed a claim, select either the BCI Member Search or the Claims link located under Dental Eligibility and Claims.

If you have concerns with how we processed a claim after checking the website:

Post Service Claims Inquiries

Submit secure on-line inquiries for post-service claims on the secure provider portal on our website bcidaho.com, using one of the two options below:

Option 1

  1. Log onto our secure website, www.bcidaho.com
  2. Select Eligibility and Claims
  3. Select Claims, then search for the claim in question and view your claim
  4. If you have a question, select Provider Contact Center
  5. After typing your question, select Continue

With option 1, the form auto populates the appropriate member, provider and claim information. Simply type your question in the notes field. The system will securely deliver your submission HIPAA compliancy guidelines.

Option 2

  1. Log onto our secure website, www.bcidaho.com
  2. Select Contact Us
  3. Select General Information under the Email heading
  4. Select a Question Category for the drop-down list. Select I have a different question, when unable to locate the claim on the website
  5. Complete the required fields marked with a red asterisk
  6. Select Submit Question

With option 2, the form auto populates your contact information based on your user name and password. The system securely delivers your submission following HIPAA compliancy guidelines.

Procedure for Submitting Corrected Claims

You can submit corrected bills electronically or hard copy.

  • Electronic format: ANSI-837D - (Dental)

You must resubmit the entire claim with all charges. In addition, both items listed below must be completed for Blue Cross of Idaho to consider an ANSI-837 dental claim a corrected claim. If these items are not completed, we will deny the claim as a duplicate.

In the 2300 loop, the CLM segment (claim information), CLM05-03 (claim frequency type code) must indicate the following qualifier code:

  • "7" - REPLACEMENT (Replacement of Prior Claim)

NOTE: In the NTE segment, add comment "corrected bill" and either the original claim number or a notation of what has been corrected.

Hard copy format:

Resubmit the entire American Dental Association (ADA) claim form with your corrections and "corrected claim" highlighted in yellow and noted in the upper right corner. Blue Cross of Idaho will adjudicate the claim accordingly. Do not attach a cover letter - it will delay your reprocess request.

If a claim denies for needing additional information such as primary payment information, x-ray, prior placement date, or a narrative, you must resubmit the claim on an ADA claim form with all charges and the requested documentation. Claims need to be submitted either electronically through the ANSI-837D format or hard copy:

Timely Filing Reminder (All Providers)

When Blue Cross of Idaho is the primary health insurance, per your provider contract, submit claims within 12 months of delivery of service.

In some cases, Blue Cross of Idaho grants an exception to the 12 month requirement if questions or disputes cause greater delay by involving third-party liability, subrogation and coordination of benefits among or between insurers or third-party payors or other situations that the provider has no control over.

We must receive corrected claims or request for payment adjustments within 12 months following the original date of payment.


Policy History

Date Action Reason
November 2014 Revised Added post service claims inquiry process. Clarified corrected claim for hard copy format
December 2012 Revised Added American Dental Association and removed 2006 for ADA clam form.
January 2012 Revised Added electronic claim corrections