November 20, 2000

Medi -865-00

TO: ALL MEDICARE PROVIDERS

SUBJECT: ELECTRONIC BILLING

PRIMARY INTERESTS: BUSINESS OFFICE MANAGERS

EFFECTIVE DATE: REVISED FROM DECEMBER 1, 2000 TO JUNE 1, 2001

Riverbend Government Benefits Administrator's electronic claims are initially processed through BlueCross BlueShield of Tennessee’s electronic claims systems. BlueCross BlueShield of Tennessee recently announced new enforcement of billing requirements which will be effective Dec. 1, 2000. Included in these requirements was a change in the electronic claims batching method for BlueCross BlueShield submitters effective June 1, 2001. This new method allows them to batch without regard to payer.

For Medicare A claims being submitted to Riverbend Government Benefits Administrator, providers will be allowed to continue to batch Medicare A claims after June 1, 2001, using either method below:

  1. If you choose to batch your electronic claims by payer, you must complete the following:
      1. The CLAIM DESIGNATOR will be required in the 10 record, field 20.
      2. The PAYER NAME must be present in the 30 record, field 8B.
  1. If you choose to submit all of your electronic claims without batching by payer, then you must complete the following:
      1. CLAIM PAYMENT TRIGGER is required in the 30 record, field 27. The CLAIMS PAYMENT TRIGGER of "X" must be present in ONE 30 record.
      1. SOURCE OF PAY (SOP) indicator in the 30 record, field 4 is required. The following indicators will be accepted:

        2. Medicare = C, TennCare/BlueCare = D, BlueCross BlueShield of Tennessee = G, Other Commercial Carriers = F

      2. PAYER ID in the 30 record, fields 5-6 must be complete.

You can choose either method using the one that most easily works within your office’s claims workflow.

If you have any questions or need additional information, please contact Electronic Commerce at (423) 755-5717.

 

THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com