New Member Prefixes and Checks With a New Look
As Blue Cross and Blue Shield of North Carolina (BCBSNC) moves forward with its technology platform change, we are beginning to process claims for members on the new system, which means that some of you may begin to see new member prefixes on ID cards or start receiving checks from us with a new look.
New Member Prefixes
The members who are being set up on the new system can be recognized by the new alpha prefixes on their BCBSNC ID cards: YPS, YPQ or YPU.
- Most member ID numbers will still consist of 14 positions; a three-position alpha prefix followed by numeric values.
- There will no longer be a “W” or “J” in the fourth position of the ID number for those members who have migrated to the new system. Those members who have not migrated to the new platform will continue to have these alpha characters in their ID numbers.
- Members who have not yet migrated to the new system will continue to have a “W” in their BCBSNC ID numbers.
- Temporarily, you will not be able to use Blue eSM to check claim status for members on the new platform during this initial transition period. However, you can still use the 276 HIPAA claim status inquiry and receive a 277 claim status response. Blue e will return a message advising you to call the Provider Blue LineSM at 1-800-214-4844 for claim status information for these members.
For claims processed for members with any of the above three prefixes, the checks you receive from BCBSNC will be different in appearance only. These new checks will be green (instead of the blue, red or teal checks generated on our current system) and will have a different signatory. This visual change is necessary to help your billing office staff (and BCBSNC) differentiate these payments from those made on behalf of other BCBSNC members.
Payments for claims processed on the new technology platform will be issued once a week. The 835 remittance advice will be included with all others you receive the next day.
Potential Split Claims
Claims submitted with multiple providers will be split by BCBSNC for processing on behalf of those members who have migrated to the new technology platform. If one part of a claim is approved and another part is not fully processed, the approved portion could be paid in one check cycle, while the other portion could be paid in a separate check cycle after the claim is finalized.
This means there is a potential for a claim submitted with multiple providers at the line level may pay in separate payment cycles. This will allow providers to receive payment promptly by allowing the approved portion of the claim to pay without being held until the other portion is approved.
Gradual Transition of Membership
As we advised you in late May, the transition to the new technology platform will be gradual. The first customer segment enrolled on the new technology suite will be new, small employer groups consisting of 1 to 50 members. Utilizing a controlled, multi-year, phased-migration approach, we expect to have all of our commercial membership migrated onto the new technology platform by the end of 2016.
There will be no changes to the fee schedule under your provider contract with BCBSNC as a result of the system change. As the system migration is internal to BCBSNC, there will be no impact to how you submit claims. However, if a sick newborn is not a covered dependent on the member’s policy, and there is no inpatient authorization on file, the claim(s) will be mailed back to the provider to be split based on the 48 hours/96 hours maternity mandate.
Thank you for your support during this transition. If you have any questions, please contact the Provider Blue LineSM at 1-800-214-4844.