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MA PAP214

Electronic Submission of Medicare Advantage Plan Claims


Provider Administrative Policy

Section
Provider Information
Policy Date
February 2008
Status/Date
Revised/May 2008

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.

Policy

Electronic Submission of Medicare Advantage Plan Claims

Medicare Advantage can receive claims electronically from providers.

Blue Cross of Idaho clearinghouse users should submit Medicare Advantage claims exactly as they would submit Blue Cross of Idaho claims.

  1. The payer name is Blue Cross of Idaho; payer ID is BLUEC.

For all other clearinghouses, contact your vendor for system set up.

Data Requirements for Medicare Advantage Claims

  1. You must code claims using the above information.
  2. Use the servicing and billing provider numbers Medicare Advantage has instructed you to use. Note: the records and fields for the provider numbers are the same as your Blue Cross of Idaho format.
  3. The subscriber number must be the number assigned to your patient by Medicare Advantage.
  4. Medicare Advantage claims will be subject to all level editing.

Reviewing status online using the secure provider portal (bcidaho.com)

Prior to logging on, you must obtain a registered user ID and password. To log on:

  1. Select Provider and enter your user ID and password.
  2. Select Eligibility and Claims located in the left navigation bar
  3. Select Claims from the available services screen.
  4. Enter begin and end dates
  5. Select Select Provider. Locate your provider and the number will auto-populate in the box provided.
  6. Selct Search and all claims submitted by the selected provider within the specified dates will appear and show current status.

Error and Acceptance Report:

  1. When you use Blue Cross of Idaho`s clearinghouse, the Error and Acceptance Report contains all Medicare Advantage claims as commercial claims. Please consider this when balancing.

Questions:

  1. How to set up your system - contact your software vendor and supply them with this document.
  2. Error and Acceptance Reports - contact the Blue Cross of Idaho electronic data interchange (EDI) department (see MA PAP102).
  3. Claim after our clearinghouse accepts it and forwards it to Medicare Advantage - please contact Medicare Advantage Customer Service (see MA PAP102).
  4. Should you require assistance in using our secure provider portal at bcidaho.com, please contact your provider services representative (See MA PAP102  for contact information).

Policy History

Date Action Reason
May 2008 Revised Language clarification

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