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Claims Submissions and Adjustments

Date:
March 27, 2020

Submitting claims electronically will allow for faster and more accurate processing.

Original Claim Submissions

For original claims, we encourage you to submit electronically through 837P, 837I, or 837D transactions. Original claims that include a report or invoice attachment should be mailed using one of the following forms:

These claims should be mailed to:

BlueCross BlueShield of Western New York
PO Box 80
Buffalo, NY 14240-0800                

*Please note: Paper Provider Inquiry Forms should NOT be used to submit original claims

Claim Adjustments

Claim adjustments must be submitted electronically through 837P, 837I, or 837D transactions or by using the Provider Inquiry transaction on HEALTHeNET.                  

We recognize claim submission types on electronic claims by the frequency code submitted. The ANSI X12 837 claim format allows you to submit changes to claims that were not included on the original claim. In the 837 formats, the codes are referred to as “claim frequency codes.” You can indicate that the claim is an adjustment of a previously submitted finalized claim by using the appropriate code.

The following codes can be used for claims that were previously processed:

Code Description Filing Guidelines  Action
5
Late Charge(s) (Institutional Providers Only)
Use to submit additional charges for the same date(s) of service as a previous claim File electronically, as usual; include only the additional late charges that were not included on the original claim We will add the late charges to the previously processed claim
7
Replacement of Prior Claim 
Use to replace an entire claim (all but identity information) File electronically, as usual; file the claim in its entirety, including all services for which you are requesting consideration We will adjust the original claim; the corrections submitted represent a complete replacement of the previously processed claim  
8
Void/Cancel of Prior Claim 
Use to entirely eliminate a previously submitted claim for a specific provider, patient, insured and “statement covers period” File electronically, as usual; include all charges that were on the original claim We will void the original claim from records based on request

Frequency codes 5, 7 or 8 (see table above) must include the original claim number from us. Adjustment requests will be rejected without the original claim number.

We will accept claim adjustment requests up to 180 days from the end of the calendar year in which the claim was processed. Any adjustment requests received after that time frame will not be processed.

Using the appropriate codes will properly identify claim submissions and reduce errors in processing that can affect your reimbursement. You can visit bcbswny.com/provider > Tools & Resources for more information about how to fill out and properly file claim forms.

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