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Notification Concerning Upcoming Reprocessing of CMS Claims Affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule Changes


This notice does NOT apply to those providers with a Medicare Provider agreement serving our Blue Medicare HMO and Blue Medicare PPO members

On March 23, 2010, President Obama signed into law the Affordable Care Act. Various provisions of the new law were effective April 1, 2010, or earlier and, therefore, were implemented some time after their effective date. In addition, corrections to the 2010 Medicare Physician Fee Schedule (MPFS) were implemented at the same time as the Affordable Care Act revisions to the MPFS, with an effective date retroactive to January 1, 2010.

Due to the retroactive effective dates of these provisions and the MPFS corrections, a large volume of Medicare fee-for-service claims will be reprocessed.

Medicare is crossing over the reprocessed claims directly to Blue Cross and Blue Shield of North Carolina (BCBSNC); but, please expect a delay at BCBSNC in processing these claims due to the large volume being received.  BCBSNC will pay interest on any claims that are adjudicated after the statutory time limits.

To help in the process, providers should verify on their Remittance Inquiry/Explanation of Payment (EOP)/Notification of Payment (NOP) if the claim was in fact crossed over to BCBSNC and if so, should NOT be submitting a duplicate claim.  On the Remittance Inquiry/EOP/NOP, it will indicate an M18 crossover/remark code, indicating it was a successful crossover.

Duplicate claims can be very costly for health care providers and health insurers, as every time a duplicate claim is filed, it must be processed. This can be counterproductive in the following ways:

  • Time is taken in the claims processing system that could be used to process claims already loaded to the system.
  • Valuable staff time is used to track duplicate claims and reconcile the system for BCBSNC.
  • Provider office staff loses office time completing and submitting the second claim.
  • Providers may be paying a billing service to resubmit a claim that was already in process to pay within a few days.

Blue eSM provides details regarding how claims were adjudicated by BCBSNC and includes claim payment disposition along with any denial reasons, and also will include a description of the denial reasons for each claim.

Providers may go to the BCBSNC Provider Portal - Important News section (http://www.bcbsnc.com/content/providers/important-news/feb22-2011.htm) to view the related article regarding CMS retroactively reprocessing these Medicare fee-for-service claims.

If you have any additional questions, please feel free to contact BCBSNC Customer Service directly at (800) 214-4844.