Blue Cross Blue Shield Nc Teachers and State Employees Health Plan and Payer Id
Reference Guide for BCBS
T he BlueCross BlueShield of North Carolina (BCBSNC) Quick Reference Guide provides information specific to BCBSNC concerning BCBS members, BCBS claims, and BCBS policies. The information in this section is in addition to the HNS/Payor Policies.
Before you provide services please make sure you are familiar with the BCBSNC Corporate Medical Policy (CMP) for Chiropractic. The BCBSNC Corporate Medical Policy (CMP) for Chiropractic is available under HNS/Payor Policies.
NOTE: LABS
BCBSNC participating providers who perform lab work must only refer lab services to in-network BCBS laboratories. To confirm if a laboratory participates with BCBSNC, simply access the "Find a doctor of facility" tool, available online at bcbsnc.com or contact the Provider Blue Line at (800) 214-4844 .
NOTE: BCBSNC Corporate Medical Policy (CMP)
BCBSNC's CMP take precedence over any information you receive from BCBS telephone representatives for the following plans:
- BCBSNC PPO and individual plans.
- NC State Employees Health Plan.
- Self Funded Plans administered by BCBSNC.
Note: While self-funded plans are subject to the CMP, the plan's specific benefits will take precedence over the CMP.
Exceptions:
- Federal Employee Program (FEP) - The BCBSNC CMP for Chiropractic is not applicable to members of the Federal Health Plan. To verify benefits for FEP members, please call the FEP plan directly.
- Out-of-State BCBS plans - The BCBSNC CMP is not applicable to BCBS Out-of-State members. Please verify benefits directly with the member's home plan.
Contact your HNS Service Representative at (877) 426-2411 to determine if a particular service is consistent with BCBSNC CMP or i f you have any questions about any BCBS related topic .
The following contains the information specific to BCBS and provides you with helpful information regarding your BCBS patients.
General Information
Eligibility/Benefits
Out of State Plans
Referral System
BCBS ID Cards
Claims Submission
Claims Inquiries
Provider Relations
General Information
Filing Claims:
DO NOT send claims directly to BCBSNC!
Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying benefits. HNS instructions for filing claims supersede information given to you by BCBSNC Representatives!
NOTE:Please remember that HNS providers must comply with BCBSNC CMP and that corporate medical policies supersede information obtained when verifying benefits.
With only a few exceptions, all claims for COVERED SERVICES provided to a beneficiary of a HNS contracted payor MUST be submitted to HNS (this includes any self-funded groups who utilize a HNS contracted payor as a third party administrator).
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Eligibility/Benefits
Always verify eligibility and chiropractic benefits PRIOR to providing any treatment. Eligibility and benefits do vary by employer group and be sure to ask for specific information on chiropractic benefits for each member.
CLICK HERE to see a sample HNS Verification of Eligibility/Benefits Form.
NOTE: Be sure to always document the name of the payor representative, the date and time of your call and the call reference/confirmation number (you will need to request this from the representative). Without this information claims will not be reviewed if processed incorrectly.
Please remember that the BCBSNC Corporate Medical Policy for Chiropractic must be strictly adhered to by HNS providers when treating any in state "BCBS" patients. This includes the NC State Employees Plan that is administered by BCBSNC.
NOTE:The customer service representatives for the NC State Employees Health Plan, and BCBSNC are not always familiar with the Corporate Medical Policy for Chiropractic. So please remember that the BCBSNC Corporate Medical Policy for Chiropractic supersedes information that you are given when verifying eligibility and benefits for BCBSNC members and State Employees.
Verifying eligibility and benefits by plan type:
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For BCBS out-of-state members: Verify eligibility and benefits directly with the member's home plan.
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BCBS in-state members: To verify eligibility and benefits for in-state policies, call the Provider Blue Line at (800) 214-4844 . Provider Blue Line Representatives are available 8:00 AM to 5:00 PM, Monday through Friday.
You can also verify eligibility using the HNS/ Blue e SM web based service for BCBS members.
If you are not contracted with Blue e SM , please CLICK HERE for information and instructions on how to sign up.
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State Health Plan members: BCBSNC is the plan administrator for State Employees. To verify eligibility and benefits for BCBS State Health Plan (SHP) members, please call the Provider Blue Line at (888) 234-2416 .
NOTE:Please remember that the BCBSNC Corporate Medical Policy for Chiropractic supersedes ANY information that you are givenwhen verifying eligibility and benefits for State Employees.
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Federal Employee Plan members: BCBSNC is the plan administrator for Federal employees covered under the Blue Cross and Blue Shield Service Benefit Plan. To verify eligibility and benefits for Federal Employee Program (FEP) members, please call (800) 222-4739 .
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Blue Medicare Supplement members: To verify eligibility and benefits for BCBS Medicare Supplement plans, please call (800) 672-6584 .
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BCBS out-of-state members: To verify eligibility and benefits for out-of-state, Inter-Plan Programs, please call (800) 676-2583 , and choose option four.
NOTE: The BCBSNC Corporate Medical Policy does not apply to BCBS out-of-state members. Please contact the home plan to verify eligibility and benefits for BCBS out-of-state members.
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Out of State Plans
BCBS Out-of-State plans are not subject to the BCBSNC Corporate Medical Policies.
Providers must verify benefits directly with the particular plan.
When providing care to members of an out-of-state BCBS plan, HNS providers are subject to the specific plan's policies and procedures, including any clinical guidelines, and utilization management programs in place with the plan. As such, providers must comply with those, including but not limited to, any requests for information from those plans or from any contracted vendor the plan may use.
If you see an out-of-state BCBS card and the ID number does NOT include a two digit suffix, you must submit that claim by paper DIRECTLY to your HNS Service Rep (via email or fax) using the CMS 1500 claim form. (Please do not mail these claims to HNS.
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Referral System
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No referral from a PCP is needed.
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When necessary to refer to another health provider, referrals within the network are strongly recommended.
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BCBS ID Cards
All BCBS ID cards have an alpha prefix which is a vital part of the member's ID number. The prefix helps identify the specific plan (or state) in which the member is enrolled. For your claims to process correctly, the entire BCBS ID number, including prefix and suffix, must be included on your claim. Please remember that if there are multiple members on a plan (such as family members), you must include the appropriate numeric suffix specific to each plan member.
The BCBS subscriber ID number should appear in box 1a on the CMS 1500 claim form without spaces or hyphens.
The ID number must include an alpha prefix, followed by an 8 digit ID number, then followed by a two digit suffix. (The two digit suffix is displayed beside the members name on the subscriber ID card.)
NOTE: The only BCBS HMO/PPO plans that are NOT filed through HNS are the BCBSNC Blue Medicare plans.
If you are uncertain about any BCBS ID card, please email a copy of the card to your HNS Service Rep and she will respond within 24 hours.
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Claims Submission
All claims for BCBS contracted plans must be submitted to HNS through the HNSConnect® system, except for secondary claims, corrected claims, or any claim with an attachment. (Exception: Providers set up to file via Office Ally™.)
CLICK HERE for information on filing secondary claims.
CLICK HERE for information on filing corrected claims.
Please ignore any instructions regarding where to submit claims by payor phone representatives. HNS instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying benefits.
In order for BCBS claims to adjudicate quickly and accurately, please remember:
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When filing claims electronically, the claim must be identified as a BCBS claim in the address section at the top of the CMS 1500 claim form (HNS/BCBS is an acceptable format) using the example address listed below:
Example:
HNS/BCBS
PO Box 2368
Cornelius, NC 28031 -
Claims must be identified in box 11c as BCBS
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BCBSNC reserves the right to deny payment if a claim is submitted after 180 days. As a participating provider, you may not bill the member for claims submitted after 180 days.
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Claims Inquiries
You can now check the status of your claim(s) on Blue e SM! If you have not signed up for Blue e SM , pleaseCLICK HERE for more details.
General Information about Claim Inquiries:
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When using the payor's automated system, you will need HNS's NPI number (1093773392), the patient's ID number, patient date of birth, the date of service, and the total amount billed from the claim submitted.
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Resubmit lost/missing claims through HNS.
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For questions relating to payment of a claim, please do not contact BCBSNC. Please use your Blue e SM online service or contact your HNS Service Rep for assistance .
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Refer to your HNS/BCBSNC Fee Schedule to confirm allowable amounts and CPT codes.
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Please remember that the BCBSNC CMP for Chiropractic must be strictly adhered to by HNS providers, for all BCBS members. This includes in-state plan members, State Health plan members, all self-funded plans and all HSA and HRA plan members.If you have questions about BCBSNC Corporate Medical Policies, please contact your HNS Service Rep.
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For tracing outstanding claims (after 30 days from your billing date), please email your HNS Service Representative and include the patient's name, DOB, subscriber ID and the dates of service in question. We will gladly trace the claim for you.
Please remember, for out-of-state members, contact the home plan directly to verify eligibility and benefits.
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Provider Relations
Questions relating to your participation with BCBSNC should be directed to your HNS Service Representative at(877) 426-2411.
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Source: http://www.healthnetworksolutions.net/index.php/quick-reference-guide
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