Claims Status and Corrected Claims
Provider Administrative Policy
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
If you have a question(s) about the status of a submitted claim, please check the claim using the Blue Cross of Idaho website at bcidaho.com or refer to MA PAP102 for contact information. Blue Cross of Idaho Customer Service will answer your questions or connect you with a provider relations representative.
Procedure for Submitting Corrected Claims
Blue Cross of Idaho Medicare Advantage member policies require claims, corrected bills and adjustments be filed within 12 months of the date of service by contracting and non-contracting providers. Blue Cross of Idaho will accept claims from active or terminated enrollees for a period of twelve months from the date of service.
The CMS timely filing guideline for institutional claims indicates the "Through" date of service is used to determine timely filing.
The CMS timely filing guideline for professional claims submitted by physicians and other suppliers that include spanned dates of service, indicate the line item "From" date will be used to determine the date of service and timely filing.
As a secondary payer, Blue Cross of Idaho Medicare Advantage will accept claims from current enrollees for a period of twelve months from the primary insurer processed the claim (paid or EOB date). As an example, another carrier may take up to 2 years to process a claim. The date shown on the other carrier Explanation of Benefits (EOB) will be used to determine the time filing requirement. If there is no paid date on the other carrier EOB, assume the claim is timely. Also applies to Worker's Compensation and subrogation claims.
CMS 1500 Form (Professional Provider)
You may submit corrected claims electronically or hard copy.
Electronic format (ANSI-837P):
You must resubmit the entire claim with all charges. Additionally, both items listed below must be completed for Blue Cross of Idaho to consider an ANSI-837 professional 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), CLM05-3 (claim frequency type code) must indicate the following qualifier code: "7" - REPLACEMENT (replacement of Prior Claim)
- 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 claim with your corrections and "corrected claim" highlighted in yellow and noted in the upper right corner. Blue Cross will adjudicate the claim accordingly. Attaching a cover letter will result in a delay of your reprocessed request.
In cases of overpayment, we will credit your remittance advice (Exceptions are government agencies such as the VA Medical Center or Armed Forces Hospital).
Include all hospital charges related to a single patient visit on the initial claim. If we receive additional claims for missing or incorrect charges, you must submit the claim in its entirety including the appropriate UB04 bill type to indicate a corrected claim. You can submit corrected UB04 forms electronically in the 837I format.
|July 2013||Revised||Added time filing language|
|June 2012||Revised||Language clarification|
|November 2008||Revised||Language clarification|
|August 2008||Revised||Language added|
|May 2008||Revised||Phone number and format changes|