A NEWSLETTER FOR MONTANA HEALTH CARE PROVIDERS
Special Edition 2013
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.
- National Provider Identifier (NPI)
- Patient’s health plan ID
- Date of birth
- Date of service
- 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.