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Previous EDI Update Bulletins!
Managed Data Systems
EDI Update Bulletin!
|Vol. 3 No. 1||
January 2001 Edition
Last month’s program updates
following payers now accept electronic claims. (For specific payer
edits, changes, and enhancements, see the global Per-Se Chicago EDIT
RELEASE NOTES, issued on 12/6/00 in software version 3.94.65.)
BENEFIT SVCS MI
HEALTH PLAN MA
ICSL PHYS THERAPY
Future releases are
scheduled as follows:
following changes are effective January 5.
New payers listed will be added automatically to your payer database. Be
sure to match the spelling of each payer with those produced in your
billing system. If you scan on the payer number instead of the payer
name, those numbers are also included.
BARNABAS SYSTEM HEALTH
BENEFIT ADMIN IL
HOSPITAL WATERMAN EMPL
MUTUAL HEALTH INS
INSURED PLANS LLC
BARNABAS SYSTEM HLTH HOS
INSURED PLANS LLC HOS
MUTUAL HLTH HOS
INSURANCE CO HOS
BENEFIT SVCS MI HOS
BENEFIT ADMIN IA HOS
OPTION ONE HOS
FUNDED PLANS HOS
HLTH PLN OF MI HOS
AND BROWN BENEFIT HOS
PLANS INC HOS
NY HOS HLTH NYHCHP
HOSPITAL WATERMAN EMPL
Corporate Health Services Groups
is the most current list of Corporate Health Services Groups that you
can send electronically using BCBSAZ as the payer name. Remember that
the group number must appear exactly as it is on the list or member’s
Local Govt Employee Benefit
Public Services (name changed: See
Construction Co Inc
Physicians Insurance Corp (CPIC)
Health Insurance Consortium
Schools Employee Benefit Plans
Riddle Aeronautical University
Public Schools Employee Trust Group
Brotherhood of Elec Workers
Electrical Contractors Assoc
Havasu School Employee Benefit Trust
Regional Medical Center
County Schools Employee Benefit Trust
Unified School District
County Employee Benefit Trust
West (formerly Arizona
Unified School District 1
Catholic Health Network
Mechanical Contracting, Inc.
Electric Power Company
Food & Commercial Workers & Employers Arizona Health &
& Employers Joint Health & Welfare Fund
Elementary School District
Combined Trust Health Plan
Regional Medical Center
from Trigon Blue Cross Blue Shield (payer ID = “ 820000)
Implementation date for new electronic remittance format
Blue Cross Blue Shield (payer
= (“ 820000”) has made changes the their electronic and paper
remittances. The implementation date for the new electronic remittance
format has been changed from December 12, 2000 to January 16, 2001. Remember
that once the new format is implemented, files cannot be created in the
a letter received from Trigon BCBS, changes will be made as follows:
accordance with the Fair Business Practices Act, 30 days notice will be
given prior to claim retractions.
will receive the allowed amount on which we based our calculations.
schedule for inclusion of Trigon HealthKeepers claims in the
remittances, which was scheduled for 1st quarter 2001 will be revised.
More information will follow regarding this.
December 5, 2000 notice to all professional providers
(excluding facilities) who file Medicare supplement claims
you may be aware, TrailBlazer Health Enterprises is now the Medicare
Part B carrier for Virginia. United HealthCare is no longer the carrier.
Effective September 2000, the Medicare Supplement program at Trigon
began receiving Medicare Part B claims directly from TrailBlazer Health
Enterprises. Since that
time, the number of duplicate Medicare Supplement claims submitted by
providers has increased considerably.
do NOT file electronic/paper Medicare Supplement claims, as Trigon
continues to receive these Medicare claims directly from the Medicare
Part B carrier. By avoiding
duplicate submissions, you can save time and speed claims payment.
the past, Medicare Part B remittances included a statement specifying
that Medicare Supplement claims were being sent to Trigon for further
payment consideration. The Medicare Part B remittances from TrailBlazer
do not provide this statement. However,
TrailBlazer does include a special message code MA18 in the detail of
each beneficiary's claim information.
The MA18 code - located to the left of the provider paid amount -
indicates that the claim has been forwarded to a supplemental insurer.
Life requires valid POS on claims
supplying Place of Service Codes (POS) when submitting claims
electronically to Great-West Life (Payer ID = “1389000”) will cause
timely and costly delays in payment. Claims with missing POS codes on
the service line are rejected and sent to paper for manual processing,
due to “edit criteria” requirements within the Great-West Life (GWL)
claims processing system.
sending claims, it is very important that you populate the POS with a
valid code. “Blanks” and “zero’s” should not be used. If the
code is unknown, the default of ‘99’ should be used. Per-Se
has made an update in the format to default a ‘99’ in the POS field,
if no POS is supplied.
avoid any confusion or delays, please make sure that all claims have a
Thank you for placing your E-claim business with
Data Systems during 2001!
appreciate the confidence and trust you have in us,
look forward to serving your needs in