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A NEWSLETTER FOR MONTANA HEALTH CARE PROVIDERS
Special Edition 2013

Introducing HCSC

Blue Cross and Blue Shield of Montana (BCBSMT) is currently in the process of forming an affiliation with Health Care Service Corporation (HCSC), a not-for-profit health insurer comprised of four different Blue plans—Blue Cross and Blue Shield of Texas, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Illinois and Blue Cross and Blue Shield of New Mexico. HCSC is the country’s largest customer-owned health insurer and fourth-largest health insurer overall, with more than 13 million members. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross and Blue Shield Association. HCSC is one of the most financially secure health insurers in the country as rated by independent rating agencies—Standard and Poor’s: AA- (very strong); Moody’s: A1 (good); and A.M. Best: A+ (superior).

The proposed alliance will bring the best of both worlds to Montana. BCBSMT will continue offering the innovative services and programs in which it shines, but its members and providers will now have at their disposal the expanded technologies available through HCSC. The alliance will bring BCBSMT and HCSC together in a business combination of dedicated people, best practices, innovative technology and other assets to advance health care excellence in the state of Montana. Being part of HCSC will enable BCBSMT to take advantage of HCSC’s scale, financial strength and technological tools. HCSC has invested in a number of capabilities, such as leading-edge customer service technology and easy-to-use website and mobile functionality.

It is important to note that the affiliation with HCSC will allow BCBSMT to maintain its local management and presence in Montana, which reflects HCSC’s and BCBSMT’s shared belief that service is best delivered on a local level, while capitalizing on the efficiencies and cost savings that combining various resources on an enterprise basis can bring through HCSC’s divisions in Illinois, Texas, New Mexico and Oklahoma.

Based on the successful integration of HCSC programs and services when the company expanded from Illinois to New Mexico, Texas and Oklahoma, BCBSMT is confident that a transition to the alliance will mean little to no disruption for its members and network providers.

Federal Employee Health Benefit Program and Bluecard Host Claim Submission after the transition

Beginning July 15, 2013, for Federal Employee Health Benefit Plan (FEHBP) and July 22, 2013, for BlueCard Host, electronic and paper claims will be processed by Health Care Service Corporation (HCSC).

Continue submitting claims in the same manner that you do today.  Use P.O. Box 7982, Helena, MT 59604 or your electronic claim submission vendor.  Other claims processing changes to be aware of are:

  • FEP – Durable Medical Equipment (DME) claims must be submitted with an MD provider ID for the certification process.
  • FEP – Met Life Dental claims will no longer be forwarded as a courtesy.  Please submit the claims to Met Life directly.
  • Claims will be reviewed in HCSC’s verification system for completeness and will be returned for additional information if necessary.

HCSC enjoys a 91 percent first-pass rate on its claims.  This means that 91 percent of claims submitted through its system are not stopped for manual review, which demonstrates a positive outcome for timely claims processing.

How Will Providers Submit an Online Inquiry for Bluecard Host and Federal Employee Health Benefit Plan?

Claim Status — To submit a request for claim status, go to the BlueCard Host and Federal Employee Health Benefit Plan (FEHBP) Claim Search area located on the bottom portion of the screen that appears after you log into bcbsmt.com.  The Health Plan ID/Sub ID and Date Submitted are required and will expedite your request.  If the Claims Submit Date is equal to or after the date that line of business was converted, you will be directed to the BlueExchange/FEP New Claim Request screen.  If the Claim Submit Date is prior to the date that line of business was converted, the claim data will be displayed similar to the way it appears today.

Eligibility/Benefit Status — Continue to submit your eligibility and benefit requests using the BlueExchange/FEP menu option on the left side of the screen.

For both claim status and eligibility/benefit requests through the BlueExchange/FEP section of our site, you will be required to enter the Provider NPI associated with your office and the claim that was submitted on behalf of the member.  If you registered for online access with your NPI number, it will be automatically entered for you.  You may have to enter the NPI number if you registered using your Montana Provider Number.

New Self-Service Options Available!

On July 15, 2013, Interactive Voice Response (IVR) system options will be available for the Federal Employee Health Benefit Plan (FEHBP) inquiries.  The IVR uses voice recognition technology, so all you have do is speak your request – the IVR does the rest!

Hours of availability are:

Monday through Friday              5:00 a.m. – 10:30 p.m. (Mtn. Time)
Saturday                                  5:00 a.m. – 2:30 p.m. (Mtn. Time)

Simply dial 1.800.634.3569 for eligibility, benefits, and claims status.  A fax-back option confirming the information provided is available.

Have Ready:

  • National Provider Identifier (NPI)
  • Patient’s health plan ID
  • Date of birth
  • Date of service

Additional Tips:

  • Avoid using cell or speaker phones
  • Feel free to interrupt
  • Speak clearly
  • Speak numbers in a single-digit format; for example, for 72, say seven two instead of seventy-two
  • Minimize background noise; mute your phone when not speaking
  • Keypad options are available

Also, as of July 22, 2013, dates of service and thereafter, BlueCard Host claims information will be available via the IVR. 

Federal Employee Program

Federal Employee Health Benefit Plan Business will be transitioned to Health Care Service Corporation in July 2013

On July 8, 2013, the Federal Employee Program (FEP) Director’s Office will begin reissuing all ID cards for Blue Cross and Blue Shield of Montana Federal Employee Health Benefit Plan (FEHBP) members.

You may request copies of the Service Benefit Plan Member ID cards on or after July 15, 2013, to ensure you have the most current information for your files.

While the Health Plan ID, known as the “R” number, will remain the same, the contact information for precertification will change effective July 15, 2013.  All other information on the ID card will remain the same.

  • The dedicated toll-free Customer Service number for the FEHBP will remain the same.  Please continue to dial 1.800.634.3569.
    • To ensure you reach the right destination, please do not dial numbers 437.5000 or 1.800.447.7828.  If these numbers are dialed, you will be prompted to hang up and dial direct the dedicated toll-free number.
  • The toll free number for precertification (located on the back of the member ID card) will change to 1.877.885.3751.
  • Please be sure to replace this new number in your office contact information.
  • Though using electronic claims submission confers many advantages to you, please continue to use the claims mailing address below when it is necessary to submit a paper claim:
    • P.O. Box 7982
      Helena, MT  59604

Federal Employee Health Benefit Plan Medicare Crossover Business will be Transitioned to Health Care Service Corporation in July 2013

Medicare primary claims will now cross over for secondary payment to Health Care Service Corporation (HCSC).  Your Provider Remittance from Medicare will show that claims have crossed to HCSC.

  • The dedicated toll-free Customer Service number for the Federal Employee Health Benefit Program (FEHBP) will remain the same.  Please continue to dial 1.800.634.3569.
    • To ensure you reach the right destination, do not dial number 437.5000 or
      1.800.447.7828.  If these numbers are dialed, you will be prompted to hang up and dial the FEP dedicated toll-free number.
  • Please monitor your Medicare Provider remittances and if claims do not indicate that they have crossed over you may submit paper claims for secondary processing.
  • You can continue to use the following claims mailing address when it is necessary to submit a paper claim:
    • P.O. Box 7982
      Helena, MT  59604

FEP LRSP Electronic Remittance Advice (ERA ) and Electronic Funds Transfer (EFT)

Who is Affected:
Providers who are receiving ERA from BCBSMT’s legacy LRSP system or who are currently enrolled in EFT.

What is Changing:
Effective July 14, 2013, ERA files will no longer be generated from BCBSMT’s legacy system, LRSP.  This is due to a change in processing systems.

Effective July 15, 2013, you will begin receiving ERAs from the new processing system, Health Care Service Corporation (HCSC) and a paper remit for 30 days.  After 30 days a paper PCR will no longer be mailed to providers receiving ERA.  An electronic version of the paper EOB will be available at that time.

What  does a Provider have to do?
There is no action on your part if you currently enrolled in EFT with BCBSMT or are in the process of enrolling.  You will automatically be enrolled to receive EFT from the HCSC system.

HCSC Paycycles:
The HCSC Paycycles are Wednesday and Friday.

FEP Claim Adjustments:
Any claim adjustments after July 15, 2013, will be processed in the HCSC system.

If you need 835 technical support regarding the formatting or have other inquiries, please call Ecommerce Hotline at 1.800.746.4614.

BlueCard Host

BlueCard Host Business will be Transitioned to Health Care Service Corporation in July 2013

BlueCard Host claims will begin processing through the Health Care Service Corporation (HCSC) starting July 22, 2013. 

  • The submission process of claims by Montana providers will remain the same.  We strongly encourage you to take advantage of the electronic claims processing provided through Health-e Web.  However, if you are still submitting paper claims, please continue to use P.O. Box 7982, Helena, MT 59604.
  • Provider Claims Registers (PCRs) for claims submitted on or after July 22, 2013, will look different because they will be coming from a new claims system.  Click here to view the new format for PCRs.
  • BCBSMT BlueCard Host staff members will work with HCSC staff members to continue processing adjustments related to claims that previously processed in our Montana claim system.  PCRs for these adjustments will continue to arrive through our current processes.

On August 12, 2013, BlueCard Host provider telephone and written inquiries will begin processing through the Health Care Service Corporation (HCSC).

  • Continue to dial 1.800.447.7828 for inquiries related to BlueCard Host claims.  You will be routed to the appropriate area through the IVR system.  Hours of availability are: 
        Monday-Friday  5:00 a.m. – 10:30 p.m. (Mtn. Time) 
        Saturday          5:00 a.m. – 2:30 p.m. (Mtn. Time)
  • For submission of paper correspondence only, please continue to use P.O. Box 4309, Helena MT 59604.  Again, the information will be routed to the appropriate area.
  • You will notice a change in your IVR experience beginning August 1, 2013, because calls will be routed through HCSC’s IVR system.
  • Please dispose of any direct phone numbers that you might have on file for BlueCard Host team members because they will no longer be able to help you with claims.

How Blue Card Host ERAs and EFTs will be handled

Who is Affected:
Providers who are receiving ERA from BCBSMT’s QNXT system or who are currently enrolled in EFT.

What is Changing:
Effective July 22, 2013, you will begin receiving ERAs from the new processing system, Health Care Service Corporation (HCSC) and a paper remit for 30 days.  After 30 days a paper PCR will no longer be mailed to providers receiving ERA.   An electronic version of the paper EOB will be available at that time.

What  does a Provider have to do?
If you currently enrolled in ERA or ERA and EFT with BCBSMT or are in the process of enrolling, you will automatically be enrolled to receive EFT from the HCSC system.

EFT
You will receive two EFTs — one from the new processing system for those groups that have been moved to HCSC and one from BCBSMT ‘s QNXT system.

HCSC Paycycles:
The HCSC pay cycles are Wednesday and Friday.

Blue Card Host Claim Adjustments:
Blue Card Host adjustments for claims that processed in the QNXT system will continue follow our current adjustment process.  Adjustments for claims that processed in our new claim system will be adjusted in the HCSC system.
  
If you need 835 technical support regarding the formatting or have other inquiries, please call Ecommerce Hotline at 1.800.746.4614.

 
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