BlueCard and Corrected Claim Submissions
Release Date: May 25, 2012
BlueCard® is a program that equips providers with one source, Blue Cross and Blue Shield of North Carolina (BCBSNC), for claims submission, claim payment, adjustments and issue resolution for patients from other Blue Plans. This means that BCBSNC has the responsibility of ensuring our network of health care providers are aware of any requirements around BlueCard claim submission policies, including appropriate submission of corrected claims.
BCBSNC continues our ongoing efforts to provide education around appropriate submission of corrected claims (i.e., BlueBookSM, provider training sessions). However, we frequently receive claims indicating they are a corrected claim when no original claim is in our system. As a courtesy, BCBSNC has refrained from mailing these claims back to the provider. Instead, we manually process these claims as an original claim submission. Beginning in August, we will no longer have the ability to continue this process due to a modification in the Blue Cross Blue Shield Association software. Consistent with BCBSNC’s filing requirements, we will reject and mail back corrected claims that have been submitted as corrected when no original claim is on file. Providers will be instructed to submit as a new claim.
As stated in the BlueCard section of our BlueBookSM provider manual, providers should follow BCBSNC standard requirements for filing a corrected claim; filing just as you would for a BCBSNC member. Additionally, the BlueBookSM provider manual states a corrected claim should only be submitted for a claim that has been paid, applied to the patient’s deductible/copayment, or denied, and you need to correct information submitted on the original claim. A claim mailed back should not be resubmitted as a corrected claim but rather as a new claim. BCBSNC will begin the transition to this process during the first week of August.
The BlueBookSM provider manual is available online at www.bcbsnc.com/providers and contains additional information about how to file a corrected claim. Healthcare providers with questions may contact the Provider Blue LineSM at 1.800.214.4844 or contact their designated Strategic Provider Relations representative.