bcbs ancillary Claims and Product Information for Providers

As a healthcare provider, understanding BCBS ancillary claims and product information is crucial to ensure smooth reimbursement and patient care. BCBS ancillary claims are submitted for services like lab tests, X-rays, and other non-medical services.

To get started, providers can access BCBS ancillary claims information through the BCBS website or by contacting their local BCBS office. BCBS offers a variety of ancillary products, including dental, vision, and hearing coverage.

BCBS ancillary products often have specific requirements and guidelines that providers must follow to ensure accurate reimbursement. For example, some products may require prior authorization for certain services.

Providers can find detailed information on BCBS ancillary products and claims on the BCBS website or by contacting their local BCBS office.

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To effectively administer bcbs ancillary products, you'll need to familiarize yourself with the available administrative tools.

These tools provide employers with the necessary guides, reports, and forms to manage their products efficiently.

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The Administration Manual is a valuable resource that outlines the process for administering bcbs ancillary products.

Employers can also take advantage of the Guide to Self-Administration, which offers step-by-step instructions for managing their products independently.

List Billing is another option, which can be facilitated through the Guide to List Billing.

Claims can be processed using the Guide to Claims.

Some of the key guides and resources available include:

As a facility looking to contract with Blue Cross NC, you'll need to meet certain requirements. To get started, you'll need to provide a copy of your CLIA Full (Level 3) certification or registration, if applicable.

Accreditation is also a must, and you can choose from organizations like the College of American Pathologists (CAP) or Commission on Office Laboratory Accreditation COLA. Medicare certification is required, and you'll need to provide a general liability malpractice insurance face sheet with current coverage dates and limits of $1 million per occurrence / $3 million aggregate.

Some facilities, like ambulatory surgical centers and hospitals, are required to be credentialed or recredentialed. Here are the specific facilities that need to be credentialed or recredentialed:

Private duty nursing facilities, on the other hand, must be accredited and have a current Division of Health Service Regulation license for each site.

Registering your NPI number is a crucial step in submitting claims and receiving direct payment through electronic funds transfer (EFT).

You'll need to register your NPI number if you want to receive direct payment to your bank account.

Only providers with a Blue Cross NC contract can receive direct payment, even if their NPI is registered.

If you're an out-of-network provider who previously received payment from Blue Cross NC, you've already registered your NPI with them.

You'll need to contact Blue Cross NC Provider Service at 800-777-1643 to continue the enrollment process, choosing option 6 to proceed.

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To become credentialed or recredentialed, certain facilities must meet specific requirements. Ambulance services, for example, need to meet these requirements.

Facilities such as Ambulatory Surgical Centers, Birthing Centers, and Dialysis Facilities are required to be credentialed or recredentialed. This includes Independent Diagnostic Testing Facilities, Durable Medical Equipment providers, and Free Standing Radiology services.

A list of facilities that need to be credentialed or recredentialed includes:

These requirements help ensure that facilities meet certain standards and can provide high-quality care to patients.

Filing an ancillary claim with BCBS requires a specific set of documents, including a claim form, itemized bill, and proof of payment.

You'll need to submit your claim within 12 months of the service date, as specified in the BCBS policy.

To ensure timely processing, it's essential to verify the claim status regularly through the BCBS online portal or by contacting their customer service team.

To file an ancillary claim, you'll need to complete a W-9 taxpayer ID form. This form can be found on the Blue Cross NC website, where you can also get help filling it out with their instructional guide (PDF).

You'll need to email the completed form to [email protected].

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) started using Verifide for primary source verification on October 1, 2020.

Verifide relies on the CAQH Provider Data Portal credentialing database, so all providers applying for Blue Cross NC credentialing and recredentialing must be registered in the CAQH Provider Data Portal.

You'll need to ensure your provider information is complete and updated in the CAQH Provider Data Portal database before you can recredential.

Here are some key things to keep in mind:

To ensure a smooth claim filing process for Private Duty Nursing with Blue Cross NC, it's essential to have your NPI registered. Have you already registered your NPI?

If not, don't worry, it's an easy step to complete. To verify your NPI, you'll need to provide a copy of your Division of Health Service Regulation license for each site.

Medicare verification is also required if applicable. This will help ensure that your claim is processed correctly.

You'll also need to provide a general liability malpractice insurance face sheet, which must include current coverage dates, provider name, address, and limits of coverage. The minimum coverage required is $1 million per occurrence / $3 million aggregate.