#BCBS TIMELY FILING HOW TO#
#BCBS TIMELY FILING MANUAL#

Availity provides administrative services to BCBSTX. If you have any questions regarding this process, please contact the BCBSTX Medicaid Network Department at 1-85 or via email at is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals.

#BCBS TIMELY FILING MANUAL#

If you file a claim with the wrong insurance carrier and then provide documentation verifying the initial claim filing was within 95 days of the date of the other carrier’s denial letter or RA form, BCBSTX will process your claim without denying it for failure to file within filing time limits.Ĭlaim and billing guidelines can be found in Chapters 5-7 of the STAR Kids provider manual and Chapters 6-8 in the STAR/CHIP manual. If Medicaid’s allowable is greater than the primary insurance payment, then the difference will be paid. Additional funds will pay according to the Texas Medicaid fee schedule, which means if the primary insurance payer pays more than Medicaid’s allowable for the service, then provider reimbursement is $0. Please remember that if a commercial payer exists, Medicaid is always the payer of last resort. If you use a different vendor, please contact them with your questions about filing BCBSTX as secondary.

#BCBS TIMELY FILING HOW TO#

If you have questions about how to file electronic secondary claims with BCBSTX, you may contact BCBSTX’s Provider eBusiness Consultants at If you need assistance from Availity (BCBSTX’s claims clearinghouse), please call 1-80 or visit.

Loop 2430 – Line Adjudication Information (if the primary claim was paid by the primary payer and service level adjustments were made at the service line level).

Loop 2320 – Claim Level Adjustments (if the primary claim was paid by the primary payer and claim level adjustments were made at the claim level).

Loop 2320 – Other Subscriber Information.

Loop 2330B – Other Payer Secondary Identifier.

When submitting electronic BCBSTX Medicaid claims as secondary, ensure the following is included: Submitting Secondary Claims Electronically When submitting COB claims, specify the other coverage in:

We cannot process the claim without this specific information. Please make sure that the information you submit explains any coding listed on the other carrier’s RA or letter.

Third-party letter explaining the denial of coverage or reimbursementĬOB claims received without these items will be returned to you with a request to submit to the other carrier or program first.

If there is a need to coordinate benefits, include the following items from the other carrier or program when submitting a COB claim: You will need to indicate “other coverage” information on the appropriate claim form if BCBSTX is the secondary payer. Submitting Secondary Claims to BCBSTX via Paper Claim Forms BCBSTX must receive Coordination of Benefits (COB) claims within 95 days from the date on the other carrier’s or program’s Remittance Advice (RA) or letter of denial of coverage. Secondary claims may be submitted to BCBSTX by paper (using the CMS-1500 and UB-04 claim forms), or electronically via Availity® or your preferred web vendor. When applicable, Blue Cross and Blue Shield of Texas (BCBSTX) coordinates benefits with other carriers and programs that a member may have for coverage, including Medicare. To keep the cash flowing, it’s important to understand secondary billing. Reach out insurance for appeal status.November 2018 How to Keep the Cash Flowing: Billing BCBSTX Medicaid as a Secondary Insurance

If previous notes states, appeal is already sent.

If we have clearing house acknowledgement date, we can try and reprocess the claim over a call.

If claim history states the claim was submitted to wrong insurance or submitted to the correct insurance but not received, appeal the claim with screen shots of submission as proof of timely filing(POTF) and copy of clearing house acknowledgement report can also be used.

If the first submission was after the filing limit, adjust the balance as per client instructions.

Review the application to find out the date of first submission.

Whenever claim denied as CO 29-The time limit for filing has expired, then follow the below steps: If claims submitted after the timely frame set by insurances, then those claims will be denied by insurance companies as CO 29-The time limit for filing has expired. Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims.

Bcbs timely filing