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heather
Canine II

Re: COB info on secondary insurance claim

I'm not sure if its nationwide, but we use the BCBS portal (Availity) here in the state of MN.  BCBS is very particular about electronic filing in our state.  (And that's being polite!)  Availity allows us to enter a claim (for instance, impacted wisdom teeth) and attach the primary EOB for coordination. It sounds like a simple process, but it is several steps and actually requires a separate form called an AUC form to also be faxed.  However, this process is the only success we have found to get a claim coordinated correctly via BCBS in our state. Also, by using Availity, we have the option to correct a BCBS claim (called a "void" claim or "replacement" claim) if ever needed.  Last time I checked, WINOMS was not able to do that for us. 

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annag
Canine III

Re: COB info on secondary insurance claim

As an update to this issue: 

We have been sending 2ndary claims per WinOMS guidelines, and BCBS MN is informing us that the attachment control # does not appear in Loop 2300 (despite us entering a medical ailment with this info and faxing the primary EOB with an AUC form). 

In addition, BCBS MN informed us that even if we fax in the primary EOB (and they can somehow locate the AUC#), this is not helpful most of the time because if the claim needs to be forwarded on to another department for processing (for example, MN forwards the claim to an out-of-state plan for processing, or to a federal plan or to a different platform, etc.)., they do not forward on the faxed EOB, they send everything electronically. So essentially, the ONLY thing that will work is if the primary insurance payment info is populated on the electronic claim and the claim is marked as "secondary" as well.

We have no way around this since this has been a state law since 2009 and we are not in compliance, so claims deny for missing COB info. Workaround would be to send a replacement claim via third party (such as Availity or HealthEC), but since the original claim was sent via Carestream, these reject stating the header info on the claim does not match.

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omsnashville
Premolar II

Re: COB info on secondary insurance claim

With our local BCBS (TN), we just have to enter a "7" for replacement or "8" for void corrective code. We enter this in WinOMS charge Extended tab > Medical Ailment > then go to the "Authorization" section and enter 7 or 8 in the Resub# area, as well as their claim reference number in the Orig Ref# area.

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omsnashville
Premolar II

Re: COB info on secondary insurance claim

YES! This is still a priority to us, as well. As Anna stated, we are not in compliance with our medical insurance contracts because we are unable to electronically send them the secondary claim information in the way they have required. Carestream's continued delay in resolving this issue (see notations above and logged calls going back to 2016) could cost us our largest payer contract. We are too big a provider to qualify for any of the "hardship" reasons they permit for still sending paper claims, so, yes, these claims must be sent electronically.

https://www.bcbst.com/providers/ecomm/Electronic-Claims-Follow-Up-Provider-0222.pdf

Additionally, since the primary information does not populate correctly on the claim form, it is constantly causing us a barrage of claims erroneously processed as primary, even when we send the proper supporting documentation. So it is costing us extra time and money to resolve those.

Our local, BCBS-TN, is transitioning to Availity tomorrow (2/17/18), so it's unfortunate that even a 3rd party option is not a viable solution (though it would have dramatically increased the duplication of data input required for our insurance coordinators anyway).

In addition to matt.ackerman , I want to get the attention of hnnobelpaula1christopher.octapaula1sstreller1

https://www.bcbst.com/providers/ecomm/bcbst_5010/Electronic_Secondary_Claim_Guideline.pdf 

CS Dental Employee
CS Dental Employee

Re: COB info on secondary insurance claim

jeremy.dempseylontaylor‌ please review this issue.   Can we discuss this?  (call me)

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