Blue Shield experiencing multiple claims processing issues, some delaying payment The California Medical Association (CMA) began receiving calls in early February from physicians reporting that the explanation of benefits (EOBs) they were receiving on PPO claims from Blue Shield of California were missing EOB reason codes and information regarding the provider dispute resolution process. Blue Shield reports that only the EOB was affected, not the issuance of payment. CMA has since learned that there were two other system issues causing delays in payment on a large number of Federal Employee Program (FEP) and out-of-state BlueCard claims. All three of these issues are related to Blue Shield’s transition to a new claims payment system. The transition began a few years ago, but the final phase of the transition was only recently completed. Blue Shield reports a system fix was implemented on March 16 for the EOB messaging error. The payor will reprocess affected PPO claims and generate updated EOBs for practices. A timeframe on the completion date of the reprocessing project was not available at the time of publication. A system fix on the BlueCard claim issue was implemented on January 16, and the payor expected to have all affected claims reprocessed, including any applicable interest, by March 18. Blue Shield reports it is working on correcting the problem affecting delays in issuing of FEP checks on a go-forward basis and will retroactively reprocess all claims automatically to include interest where applicable. Blue Shield did not, however, provide any specific dates for this fix. Practices do not need to resubmit affected claims. CMA will continue to monitor this issue closely and will provide updates as they are available. March 31, 2016 Managed Care BlueCard, Blue Shield 0 0 Comment Read More »
Anthem Blue Cross to move eligibility, benefits and claim status inquiry functions to Availity Web Portal in March Anthem Blue Cross has advised that effective March 14, 2014, patient eligibility, benefits and claim status inquiry functions will transition from its ProviderAccess portal to the Availity web portal. As of that date, practices will only be able to access this information via the Availity web portal. While BlueCard eligibility, benefits and claim status functions will also transition to Availity, the BlueCard Advisor function that allows practices to determine which Blues plan to send the claim to will continue to be available on the ProviderAccess portal. In order to access information on the Availity web portal, practices must first register and sign the Availity Organizational Access Agreement. To register for the Availity web portal, visit www.availity.com/providers/registration-details. Anthem Blue Cross is also offering free 30-minute webinars on the ProviderAccess functionality shutdown and Availity registration process. The webinars will take place on the following Wednesdays, 10 to 10:30 a.m. February 12 February 19 March 12 No prior registration is required. Practices interested in attending should visit the Provider Network Education page on the Anthem Blue Cross website or click here on the date of the webinar to join. Practices with questions on the Availity site or registration can call Availity at (800) AVAILITY (282-4548). Availity is also offering a series of provider workshops and webinars, from new user training to specific modules on various portal functionality. To view the full schedule, visit www.rsvpbook.com/AvailityWest. February 5, 2014 General BlueCard, Managed Care, Anthem Blue Cross, Insurance/Reimbursement 0 0 Comment Read More »
