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Controlling costs


Helping our members to maximize their health care benefits is important to us. We strive to offer exceptional benefits at the most affordable costs. There are many ways that together, we can work to control the increasing cost of health care for our members - your patients - and their families. One easy method to help control costs is through the accurate reporting of information in claim submissions; items like ensuring the correct member's alpha prefix, numeric suffix & ID are included, and reporting up-to-date other coverage information for the processing of coordination of benefits (COB).

A complete and accurate member identification number affixed with the appropriate alpha and suffix characters is necessary for properly routing a claim for benefits processing. Current other coverage information is needed to correctly apply a member's benefits when there is more than one health care payor responsible for benefits issuance. A claim submitted with inaccurate COB information can result in a delayed payment or the inability for a payor to process a claim. Additionally, inaccurate COB information can lead to duplicate primary benefits payments from multiple payors, causing claims adjustments and bookkeeping issues for provider’s office staff.

Claims adjustments and bookkeeping corrections can be time consuming and costly. Together, we can help to control these administrative costs by taking these easy measures:

  • When submitting claims, please make sure that the member's complete ID is provided.
  • Please also ensure that any other coverage information is accurately reported with the first submission of a patient's claim.
  • Include all COB amounts paid by the patient's primary payor by reporting any applicable amounts in the correct fields of the claim form.

To find out more about claims submission with Blue Cross and Blue Shield of North Carolina (BCBSNC) and the COB process, please access our online Blue Book provider manual located on the Web at http://www.bcbsnc.com/content/providers/blue-book.htm or contact your local regional representative.