Submitting Claims

At BlueCross BlueShield of Western New York, we are committed to fast and efficient claim processing. In order to prevent delays, billing errors, and other potential setbacks, please review the information below to help you manage and submit claims. 

 

Appeals Process

Submit all timely filing appeal requests in writing, stating the reason for the delay of submission beyond 120 days. The claims you are appealing must be on paper and attached to your appeal. Please keep copies of the information you send for ease in identifying claims that will be approved/denied. (Refer to Stat Bulletin Volume 16, Issue 12 for details). 

 

Clinical Editing

BlueCross BlueShield of Western New York offers an application designed to assist providers by representing the relationship(s) between CPT codes and the supporting clinical rationale for their bundled or unbundled states, modified by date of service, patient age, gender, and place of service. Learn more.

 

CMS-1500 User Guide 

In a continuing effort to reduce administrative costs and improve turnaround, BlueCross BlueShield of WNY requires complete CMS-1500 information on all claims, including National Provider Identifier. Incomplete claim forms will be returned to you for required information. Learn more.

 

Electronic Claims Filing

We require all participating providers to submit claims electronically. Claims may be submitted electronically 24/7. We accept institutional, professional and dental claims electronically. This includes adjustments and COB claims.

The electronic Payer ID for BlueCross BlueShield of Western New York is 00801 and is recognized by most clearing houses and vendors in order to route electronic claims to BlueCross BlueShield of WNY. You may need to contact your clearinghouse to see if they use a different BlueCross BlueShield of WNY Payer ID. Learn more.

 

National Drug Codes (NDC)

BlueCross BlueShield of Western New York requires the use of NDCs and related information, along with the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes when drugs are billed on professional and ancillary claims (electronically or paper). Claims submitted without the necessary NDC, information will be returned. 

 

Taxonomy Codes - Definitions and Claim Use

Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten character alpha-numeric code that enables providers to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual provider and organizational provider level. 

A provider can have more than one taxonomy code. It is critical to register to all applicable taxonomy codes with NPPES and to use the correct taxonomy code to represent the specific specialty when filing claims. Please make sure you provide your taxonomy codes to BlueCross BlueShield of Western New York to ensure our records are up to date. This will assist in more accurate and timely processing of claims. 

 

Timely Claim Filing

As of April 1, 2010, all claims must be submitted to BlueCross BlueShield within 120 days from the date of service. Claims that are submitted after 120 days will be denied. The calculation begins from the date of service, discharge date or last date of treatment up to 120 days, including weekends. Do not delay the billing of a claim for any reason. 

Refer to Section 13 of the BlueCross BlueShield of Western New York Provider Reference Manual to find out more about submitting claims, acceptable proof of timely filing and more. Learn more.

 

UB04 User Guide

The Uniform Bill (UB-04) is the standardized form for institutional services. This is a guide to help with completion of the UB094 form for your patients with BlueCross BlueShield facility coverage. Learn more

 

For additional information about submitting claims, refer to Section 13 - Claims & Billing in our Provider Reference Manual.