Providers Archives - Page 10 of 10 - Blue Cross Blue Shield of Wyoming

Reminders and Helpful Tips – May 2, 2019

We’re continuing to get claims through the system as quickly as we can and have added additional staff to work on these priority claims.

Some common errors that can delay processing times for claims and authorizations are included below. Please take a few minutes to review this information.

Taxonomy Codes

Our new system now requires you to include your taxonomy code on professional claims. The taxonomy code should populate in box 24j, please be sure to include indicator “ZZ” in box 24i. If you’re unsure of your code give us a call and we can assist.

Prior Authorization

Inpatient hospital stays require prior authorization irrespective of the prior authorization for the procedure. Hospitals and surgeons need to coordinate submission of prior authorization requests for procedures requiring an inpatient hospital stay.

NCCI

Please remember that we are now compliant with National Correct Coding Initiative (NCCI). If you have seen an increase in claims returned to you for corrections, it may be a result of CCI edits. Many claims now need a specific modifier in order to pay. There are many public resources available to guide NCCI coding.

How to fix the Eligibility and Claims Status Error – “Provider Not Found”

If you have received an error “provider not found” when making an inquiry, verify the NPI you’re using. The correct NPI to use is the Organization’s Billing NPI. Using the Physician’s (rendering) NPI will cause this error to occur.

Prefix Reminder:

As a reminder, new member ID numbers will have a 3-character prefix followed by 12 digits. For your information, here are the new ID prefixes.

Network	Product Type	ID Card Prefix
BlueSelect	PPO	ZSK
FEP	PPO	R
Kid Care CHIP	PPO	ZSC
Medicare	MedSup	ZSM
Wyoming Select	PPO	ZSF
Wyoming Select	PPO	QWY (previously ZSH)
Wyoming Total Choice	PPO	YWY (previously ZSP)
Participating Provider	Trad	ZSD
Participating Provider	Trad	ZRW (previously ZSA)
Participating Provider	Indem	ZRW (previously ZSA)
Participating Provider	PPO	ZRW (previously ZSA)
Wyoming Choice	PPO	ZYW (previously ZSP)

Fax Numbers

For faster service, please send requests/documents to the correct fax number below.

Document Destination	Fax Number	What should get sent here?
Authorizations	307-432-2917	Pre-authorization request Initial inpatient hospital authorization Pharmacy authorizations
Concurrent Review	307-432-2756	Updates and records for current inpatient hospital stay
Appeals	307-432-2942	All pre and post service appeals Claim Adjustment forms and records
Medical Records	307-635-9366	Requested medical records Records for denied claims and authorizations

Call Center Hours

Please remember our call center is now open from 7:00-8:00 a.m. exclusively for provider calls. Call 888-359-6592 to take advantage of this option for reduced on-hold time.

Reminders and Helpful Tips – March 21, 2019

NCCI Compliance:

Our new claims processing system is fully compliant with the National Correct Coding Initiative (NCCI) and you may have noticed some slight coding changes. To ensure quick and accurate claims processing make sure your office staff and third-party billing vendors are using NCCI edits.

NEW Member ID Numbers:

Whether submitting claims electronically (preferred method), or by paper, be sure to use the new member ID number for service dates after 1/1/19. New member ID numbers will have a 3- character prefix followed by 12 digits and can be found on the member’s new ID card.

For your information, here are the new ID prefixes.

ID Card Prefix

ZSK

ZSC

ZSM

ZSF

QWY (previously ZSH)

YWY (previously ZSP)

ZSD

ZRW (previously ZSA)

ZYW (previously ZSP

Call Center Hours:

Please remember our call center is open from 7:00-8:00 a.m. exclusively for provider calls. Call 888-359-6592 to take advantage of this option for reduced on-hold time.

Fax Numbers:

See below for the best place to fax your requests/documents. Faxing more than 75 pages? Give us a call at 888-666-5188 so we can discuss other options.

Document Destination	Fax Numbers	What should get sent here?
Authorizations	307-432-2917	Pre-authorization request Initial inpatient hospital authorization Pharmacy authorizations
Concurrent Review	307-432-2756	Updates and records for current inpatient hospital stay
Appeals	307-432-2942	All pre and post service appeals Claim Adjustment forms and records
Medical Records	307-635-9366	Requested medical records Records for denied claims and authorizations

Select Services No Longer Require Case Management

We’re streamlining case management services to provide you with faster and easier service and have removed the following services requiring prior authorization:

Bili Lights
Enteral Feeding
Home Health Care
Outpatient Hospice
Physical Therapy
Occupational Therapy
Speech Therapy

This change is effective January 1, 2019. Group specific benefit limitations may apply. Providers are encouraged to verify member benefits using the eligibility and benefits tool at Availity.com.

Please remember our call center is now open from 7:00-8:00 a.m. exclusively for provider calls. Call 888-359-6592 to take advantage of this option for reduced on-hold time.

New Member Cards

Reminder: All BCBSWY members have received new ID cards for 2019. Be sure to request the new ID card from BCBSWY members when you provide care.

For your information, here are the ID card prefix’s with new ID prefixes noted.

Network	Product Type	ID Card Prefix
BlueSelect	PPO	ZSK
FEP	PPO	R
Kid Care CHIP	PPO	ZSC
Medicare	MedSup	ZSM
Wyoming Select	PPO	ZSF
Wyoming Select	PPO	QWY (previously ZSH)
Wyoming Total Choice	PPO	YWY (previously ZSP)
Participating Provider	Trad	ZSD
Participating Provider	Trad	ZRW (previously ZSA)
Participating Provider	Indem	ZRW (previously ZSA)
Participating Provider	PPO	ZRW (previously ZSA)
Wyoming Choice	PPO	ZYW (previously ZSP)

Top Billing Issues and Errors and How to Avoid them for Professional Providers

Claims processing experts identified the common adjudication errors that cause claims to be suspended or denied. To ensure timely and accurate processing of claims please review these recommendations.

Some common issues…	CORRECTION or REASON
Bilateral Procedures	When billing a bilateral procedure that requires a modifier, if done bilaterally use modifier 50 and bill one unit per left/right combination. Do not bill an RT and LT modifier separately. If multiple distinct bilateral procedures are done on a patient, for example, multiple bilateral spine injections, it is permissible to bill multiple units.
Incorrect Provider Number (NPI)	BCBSWY needs your correct NPI on file to process your claim properly. If practices are unsure which National Provider Identifier (NPI) to use, contact BCBSWY Provider Relations.
Incorrect Taxonomy code	Submit a valid taxonomy code, in box 24j on a HCFA 1500. For providers with multiple specialties please use the taxonomy code that reflects the services provided.
Invalid address or zip code	Submit the physical street address for the billing and/or service facility NOT PO BOX or Lock Box. Submit all 9 digits of the billing and/or service facility zip code without zeros in the last four positions. Contact Provider Relations if your location does not have a +4 zip.
When billing for anesthesia and the billing provider is not a CRNA	One of the following anesthesia certification modifiers must be submitted: AA-AE, GC, QX, QY, WP
Related anesthesia procedure code not found for anesthesia service.	Submit surgery code for the Anesthesia being administered.
NPI for referring provider not found	For certain services (labs, imagining, DME) the NPI of the referring provider is required on the claim.
CCI Edits	Correct Coding Initiative (CCI) edits are now applied to BCBSWY claims. Payment for these services are included in the allowance for another service with which it was provided. These services cannot be paid separately.
Non-participating Provider Benefit Denials	This service is only covered when performed by a participating provider. Therefore, no payment can be made.
Line Item Missing Charges	Line items requires a provider charge.

Top Billing Issues and Errors and How to Avoid them for Institutional Providers

Some common issues…	CORRECTION or REASON
Bilateral Procedures	When billing a bilateral procedure that requires a modifier, if done bilaterally use modifier 50 and bill one unit per left/right combination. Do not bill an RT and LT modifier separately. If multiple distinct bilateral procedures are done on a patient, for example, multiple bilateral spine injections, it is permissible to bill multiple units.
Invalid Other Carrier Payer ID	Applicable coordination of benefits/other insurance information and/or documentation is not accompanying the claim level. Other Payer Primary ID must match the line level Other Payer ID.
Present on Admission	Present on Admission Indicator must be submitted. Report POA indicators in diagnosis segments.
Invalid Operating Physician ID	An Operating Physician must be reported on outpatient claims when the Revenue Code = 360- 369, 490-499, or 750-759 and a HCPCS code = 10000-69999.
Invalid Patient Status Code	Patient Status must be 30 (still patient) if using a Bill type of 2 or 3 (interim bill).
Service Included in Payment for Another Service	Payment for this service is included in the allowance for the service with which it is provided. This service cannot be paid separately.
Out of Network Benefit Denial	The patient’s coverage does not provide for services when performed by an out of network provider. Therefore, no payment can be made.
Medicare Crossover Issue	Patient has effective Medicare Part A or B coverage but the claim does not contain Medicare payment information.

Improving Our Services

You can now verify eligibility and benefits online through the Availity Provider portal.

To get started, look under the “Patient Registration” tab. Features include a patient cost estimator, easy-to-read coverage and benefits summary, and benefit coverage details for specific services.

You can watch a quick demo, which is available in the tool once you start a new request, that will help you better understand how to verify benefits.

Extended Call Center Hours. Beginning Monday, November 19, our Provider Services Call Center will open at 7:00 a.m. to answer provider calls regarding claim status checks and confirmation of prior authorization requests.

Please note, that while we are making progress in processing prior authorization requests, you should anticipate longer than usual processing times. BCBSWY continues to prioritize patient safety and requests that require an urgent response.

While it will not alleviate on hold time, we hope that earlier staffing may help reduce waiting times. We encourage you to take advantage of our extended hours.

To reach Provider Services call 888-359-6592.

Sign Up for Electronic Remittances

Institutional and professional remittances are now available using Availity. BCBSWY is no longer mailing remittances for these type of claims.

To get started register and login to Availity and follow these simple steps:

Step 1: After Logging in Click “My Providers” then go to Enrollments Center

Step 2: Select ERA Enrollment

Step 3: Click Claims & Payment Ɩ Select EDI Reporting Preferences Ɩ Click Claim Payment/Advice tab.

Reminder: Prior Authorization Requests

As we transition to a new utilization management system, you may experience a longer than usual wait time for prior authorization approvals including preadmission reviews.

Some important things to note that will help expedite requests:

NEW! Authorization Request form available at: BCBSWY.com/docs/providers/precertification.pdf and attached to this email.
NEW! Fax Number fax authorization requests to 307-432-2917
Autofax Response an automatic fax response when a determination is made, followed by mail confirmation will begin in October

We know this is an inconvenience for the immediate future and we appreciate your patience. We’re working to add other changes to our system that will make the prior authorization process easier, faster and more efficient for providers.

Prior Authorization Requests

As we transition to a new utilization management system, you may experience a longer than usual wait time for prior authorization approvals including preadmission reviews. One of the coming enhancements is a new fax system that will allow PAR requests to be received digitally and automated into our new system. In the future, this will significantly reduce the response time on authorization requests.

Some important things to note that will help expedite requests:

NEW! Authorization Request form available at: BCBSWY.com/docs/providers/precertification.pdf and attached to this email.
NEW! Fax Number effective 9/17/18 fax authorization requests to 307-432-2917
Autofax Response an automatic fax response when a determination is made, followed by mail confirmation.

New and Updated Medical Policies

Effective September 1, 2018, BCBSWY has updated, and added new medical policies. These updated policies will offer clarification to authorization requests or claims denials and are necessary to support our new claims processing system. You can access our updated medical policies through the BCBSWY Availity payer space or by clicking here.

For the time being, updated policies will be available to view in THOR. In the near future, medical policies will be available through Availity or BCBSWY.com in an easy-to-search format.

Taxonomy Codes

Prior Authorization

NCCI

How to fix the Eligibility and Claims Status Error – “Provider Not Found”

Prefix Reminder:

Network

Product Type

ID Card Prefix

Fax Numbers

Document Destination

Fax Number

What should get sent here?

Call Center Hours

NCCI Compliance:

NEW Member ID Numbers:

ID Card Prefix

Call Center Hours:

Fax Numbers:

Document Destination

Fax Numbers

What should get sent here?

Network

Product Type

ID Card Prefix

Some common issues…

CORRECTION or REASON

Some common issues…

CORRECTION or REASON

Reminder: Prior Authorization Requests

ACA – Online Event Registration Form