Direct Claims Entry - Blue Cross of Idaho · 2016-08-11 · Direct Claims Entry Instruction Guide...

Direct Claims Entry

Instruction Guide

providers.bcidaho.com

Purpose: To enable providers to submit professional claims electronically to Blue Cross of Idaho

without using an intermediary or clearinghouse.

Direct Claims Entry Instruction Guide

08/08/16

Blue Cross of Idaho designed a secure Direct Claims Entry (DCE) tool to enable providers to submit

professional claims electronically without using an intermediary or clearinghouse. We developed a

simplified version of the standard CMS-1500 claim form, which is familiar to many providers, without

requiring as many data elements.

You can submit CMS-1500 claims electronically using our Direct Claims Entry, an intermediary or a

clearinghouse.

Excludes: Dental (ADA form) and Facility (UB04 form) claims

Exception: Long Term Care providers may use to enter and submit claims directly to Blue Cross of

Idaho. Due to our Medicare Medicaid Coordinated Plan (MMCP), we have come up with a solution for

your Long Term Care facility claims. Please complete the claims form with the following information to

submit your claims.

Place of Service; SNF – 33 or LTC – 99

CPT/HCPCS – T5999

Admit date, please indicate in the notes field the actual admit date

Rev code – please indicate rev code in the notes field


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Step A - Accepting the Disclaimer

1. Select the “Accept” at the bottom of the page to advance. This is required upon each entry

into the application.

Note; Claims you successfully submitted to Blue Cross of Idaho are housed as a Received Claim for 30

days. After that time, we purge claims from the DCE system.


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Step B – Claim Search / List

1. Saved/Failed Claims - This radio button holds claims entered and saved but “not”

completed or submitted.

a. Choose a Rendering Provider by selecting the down arrow, then selecting the

address line for your provider

b. Select the radio button Saved/Failed Claims

c. Select Search

d. Data will populate below the search button if there are claims needing to be

completed or deleted.

i. To complete a claim select the Edit button on the right that looks like a pencil.

Finish or correct the entry of the claim, then select Submit Claim at the

bottom of the page.

ii. To delete a claim select the “X” button to the right in red. It will ask you “are you sure you

want to delete this claim?” Choose Yes or No.

Luna Blue 01/01/1969


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2. Received Claims – This radio button displays claim(s) submitted and received by Blue

Cross of Idaho in the past 30 days. After that time, we purge claims from the DCE system.

a. Choose a Rendering Provider by selecting the down arrow, then selecting the

address line for your provider

b. Select the radio button Received Claims

c. Select Search

d. Data will populate below the search button if there are claims received by the

selected servicing provider.

i. To view a claim, select the spy glass icon to the right. It will display a CMS-

1500 with the details entered. You may print the claim from this view.

ii. To view any documents you have attached, select the paper clip icon to

review. Note: you will not be able to add or remove documents.

Luna Blue 01/01/1969


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Step C – Create New Claim

1. To start a claim select Create New Claim. No other boxes need to be selected.

2. Patient Search –

a. Date of Service – fill in the oldest date you will be billing with.

b. Patient ID Number – Alpha prefix (not case sensitive) with ID number; no

spaces between the alpha prefix and ID number.

c. Then enter ONLY one, the Date of Birth OR the Last Name

d. First Name is optional

e. Select Search


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f. Results will display under Search. Select the Create Claim on the approperate

member line.

g. Patient is a Medicare Medicaid Coordinated Plan (MMCP) member you will see

the following box (below). Their alpha prefix starts with XMX.

i. Select the HCBS/LTSS if you are billing for Medicaid care services such as

CBRS mental health, home care, personal services, assisted living, etc.

ii. Select BCI Medical if you are billing for regular medical services such as

doctor office visits, physical therapy, behavioral health counseling, etc.

XMM999999999 Blue 01/01/1969 Luna


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h. BlueCard Members - If you encounter the following message, you might be entering

a BlueCard member with membership with another BlueCrossBlueShield plan.

i. You may contiune by selecting Yes. We will forward the claim to the home

plan for eligibility and benefits before Blue Cross of Idaho processes for

payment.

3. Blue Cross of Idaho Medical Claim (CMS-1500 version) – only the red asterisk will need

to be populated.

a. Choose a Rendering Provider: Select the drop down arrow, then select the

servicing providers address line.

b. Patient’s Information

i. If the patient is a member, we will auto populate the information

ii. If the patient is a BlueCard member, you will be asked to fill out the member

information completely

XMM999999999

Luna Blue

01/01/1969


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c. Is there another health benefit plan? Does your patient have a primary insurance

carrier before Blue Cross of Idaho?

i. Select No – you move to the next red asterisk

ii. Select Yes – you will be asked to attached a copy of the primary

explanation of benefit (EOB) and fill out the Other Insured’s Information

section.

iii. If Yes and a BlueCard claim, you are required to indicate in the “Additional

Claim Information” box the other payment liability (OPL) value. Enter one of

the following;

1. BL - Blue Cross/Blue Shield

2. CI - Commercial Insurance

3. MA - Medicare Part A

4. MB - Medicare Part B

5. MC - Medicaid

6. WC - Work Comp

Blue Linda


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iv. Add “PDF”Attachment to upload your document; Primary EOB

d. Resubmission Code & Orginal Ref No. - These fields assist in resubmitting a

corrected claim or voiding a claim.

i. Resubmission Code – select the down arrow and chose 7- resubmit claim

or 8- voiding a claim

ii. Original Ref No. – enter the original claim number of the first claim. The

claim number is found in the Claims Status tool or on your Remittance

Advice.

e. ICD Indicator - This indicates for diagnosis code sets

i. ICD-9: For diagnosis codes with dates prior to 10/1/2015

ii. ICD-10: For diagnosis codes with dates on and after 10/1/2015. The tool

defalts to ICD-10.

f. Diagnosis – add your primary diagnosis code and up to 11 more secondary codes

by selecting the Add Diagnosis button.


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g. Service – Services proformed

i. Date of Service (DOS) – enter individual dates of services on each line

1. Exception – MMCP provider may enter a week or month at a time.

ii. Place of Service (POS) – Enter two-digit code

iii. CPT/HCPCS code – enter procedure code

iv. Modifier – optional

v. Related Diagnosis –

1. Primary – if only one diagnosis code “a” is correct, you are complete.

If you have mulitple diagnosis codes, you need to indicate which code

is primary. Then go to the Other(s) box to put in order.

vi. NDC – National Drug Code

vii. Total Charges – total charges for all lines

viii. Days/Units – Total day or unit count

ix. EPSDT - Early & Periodic Screening, Diagnosis & Treatment (EPSDT) should

be marked if the patient is a Medicaid member of Blue Cross of Idaho which

the following services are being billed; normal newborn or well child exam.

x. Add Service – Select if there are multiple lines of services that need to be

entered.


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h. Patient Data –

i. Patient Account Number – optional, the account number from your client

files

ii. Accepting Assignment – You are indicating that the case is being assigned

to you and payment should be sent to you. If you indicate No, you are

indicating that payment should be sent to the patient.

iii. Patient’s or Authorized Person’s signature - The patient’s signature or the

statement “signature on file” in this item authorizes payment of medical

benefits to the physician or supplier. Select one of the four buttons given.

iv. Federal Tax ID Number – Enter your tax identification number and select the

SSN or EIN that applies.

i. Service Facility Location

i. Same as Billing Provider Information – mark if the services were

performed at the same location as the provider’sbilling address. If not, enter

the location where services were rendered into the red asterrisk fields. For

example: the patients home.


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4. Save, Submit or Cancel

a. Save – This retains the information you entered in the claim, allowing you to go back

in and modify the claim prior to submission under the Save/Failed section on the

front page of the tool.

b. Submit Claim - Two possibilties for replies

i. If all information is entered appropriately the message will say “This claim has

been submitted for processing.”

ii. If field errors or validation errors are present, you must select OK and go

back to correct the highlighted field.

iii. Once you hit the submit button, your claim will transmit to Blue Cross of

Idaho. You cannot edit a claim after it has been submitted.

c. Cancel – Will delete what was entered on the form.

Direct Claims Entry - Blue Cross of Idaho · 2016-08-11 · Direct Claims Entry Instruction Guide...

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