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Ensuring Timely Secondary Insurer Payments from BlueCross BlueShield 

Date:
February 20, 2020

To: All Providers

Electronic Coordination of Benefits Claims

We can receive coordination of benefits (COB) claims electronically, so you don’t need to send us a paper claim unless there is a required attachment.

  • Electronic COB claims are most efficient and should be submitted for Professional (837P), Institutional (837I) and Dental (837D) services
  • If you are receiving an electronic remittance (835) from the primary insurer, the information received on the 835 should be incorporated into the secondary fields on the 837 you are submitting to us
  • A paper claim is needed for COB only when a paper attachment, such as medical notes or documentation for workers’ compensation/no-fault claims, is required

Medicare Crossover Claims

The crossover program allows Medicare to electronically transfer claims along with an explanation of Medicare Benefits (EOMB) directly to Medicare's supplemental insurance payers (such as Medigap). This only applies when Medicare is the primary insurer and BlueCross BlueShield is the secondary insurer.

Outlining the Medicare crossover process:

  • When an EOMB has been crossed over to us, we will receive it and process it
  • If an EOMB Medicare sent to you from Medicare tells you a claim has not been crossed over, you may then send us an electronic claim immediately  
  • If you don’t get secondary reimbursement from us, please wait 30 days from the EOMB date (date of Medicare adjudication) before submitting a claim to us; this will reduce duplicate claims processing

Submitting a Medicare secondary insurer claim (if necessary):

  • Medicare claims can be submitted electronically using the Institutional (837I) or Professional (837P) formats
  • You don’t need to submit the paper EOMB if all information is submitted on the 837 form
  • If you are receiving an electronic remittance (835) from Medicare, you should incorporate the information on the 835 into the secondary fields on the 837 you are submitting to us

Tertiary claims must be billed via our preferred electronic method, or on paper.

You can visit HEALTHeNET to check the status of claims.

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