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Claims Inventory Update as of May 5, 2014

We wanted to provide you with an update to the information we shared with you on April 11 and on our progress addressing our claims inventory. We continue to take an aggressive approach to reducing claims inventory that is outside of our historical processing timeframes.  Here are the updates for each of our major lines of business as of the end of April: 

  • Commercial Claims
    • Our inventory reduction plan has further reduced the inventory of aged claims 30 days or older, corrected claims, and claims processing cycle times overall. We expect to resolve the remaining inventory over the course of the next two to three weeks.
    • We are focused on implementing additional automation to address duplicate claims that will improve overall claims processing cycle times.
    • Implemented process improvements to address certain claims suspend situations.


  • State Health Plan Claims
    • Reduced duplicate claim volumes by more than 50 percent during the past two weeks using automated tools to speed up the process.
    • Achieved a 35 percent reduction in inventory of aged claims older than 30 days during the past two weeks.
    • Nearing completion of our aged-claims processing to attain inventory levels within acceptable ranges within the next 30 days.


  • Federal Employee Program Claims
    • Resolved more than 50 percent of the aged claims inventory during the past three weeks. Expect to resolve the remaining inventory within the next two to three weeks.
    • Implemented three system enhancements that will increase the timeliness of claims processing and payments immediately and into the future.

For Blue MedicareSM Claims

While Blue Medicare claims have not been significantly affected by the system upgrades impacting the other lines of business, we have done the following to address our Blue Medicare claims inventory:

  • Added staff to reduce claims-on-hand levels, and created a SWAT team to resolve aged claims.  Realized a reduction in claims inventory of 28 percent in April.
  • Identified approximately 3K claims that were submitted incomplete by the provider.  These claims were returned to providers by April 30 so that providers can resubmit with complete information. 
  • Implemented system enhancements in late April to automatically adjudicate certain claims that were otherwise returned to the provider because they were incomplete.  As a result, providers should begin to see substantial reduction of this particular issue by mid-May.
  • Identified high volume of claims that need to be mailed back to providers as they cannot be successfully processed due to missing, incomplete or inaccurate information. Mail backs of these claims to providers began in late April.


How to Help Ensure Your Claims Are Processed As Quickly as Possible

In order for us to continue to move forward in improving our claims processing cycle times, here are some ways you can help:

  • Please do not submit duplicate claims, as they increase our inventory and impact our timeliness in processing your claims.
  • Make sure claims are complete and accurately coded before submitting them for processing.
  • Include NPI numbers, Medicare number as appropriate, and your tax ID on the claim.
  • Keep your contact information, including address and phone number, up-to-date with us.
  • Submit any requested or required information in a timely manner.
  • Do not send medical records with claims unless we have specifically requested them.
  • Check claims status on Blue eSM (Health Trio link for Blue Medicare claims) prior to calling customer service or resubmitting the claim.  When checking claims status on Blue e, please note the “Pended Status,” as that will indicate if the claim is fully processed or not at this time. 

In order to better assist you, we have created an escalation process to address your concerns about aged claims. If you have outstanding claims greater than 60 days, and you've not already spoken to one of our provider specialists, call us at 1-800-214-4844 for assistance.