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THIN/Electronic Claims
Q. Is additional information about reports available through THIN?
A. You can find a quick reference guide to THIN reports online. It provides the information necessary to navigate through all the reports currently available. You can select the reports you wish to receive.
Q. Can we send in a corrected billing electronically?
A. Corrected and Late Charge Facility claims may be filed electronically using the correct Type of Bill combination. For Professional Provider claims, we recommend that you complete the Physician and Provider Reconsideration and Appeal Form using the “Corrected Claim” option at this time. Once additional information is received from the Texas Department of Insurance, BCBSTX will notify you about how to submit corrected CMS 1500 claims electronically.
Q. Can you check eligibility on-line if you do not use THIN as your clearinghouse?
A. Yes. To do so, complete the Internet Enrollment (Claims Status and Eligibility) form.
Q. I received a new BCBSTX provider number, but I'm having problems filing electronically with this number. What do I need to do?
A. Contact the THIN EDI Helpline at 877-334-8446 or your THIN EDI Marketing Representative to ensure all of the proper paper work has been submitted and the new number has been activated for electronic billing.
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Q. How long does it take to get set up for Electronic Funds Transfer (EFT)?
A. The setup process for direct deposit takes about 10 business days from the day the paperwork is received in the THIN office. The paperwork cannot be faxed, and the original must be in-house before the setup process is started. You must qualify for Electronic Funds Transfer (EFT).
Q. Does THIN work with other insurance companies?
A. Yes. Information regarding other carriers may be obtained at the THIN Web site. (Forms are found under the THIN network payers section - separate list for professional and institutional payers).
Q. What is the process for submitting attachments when filing electronic claims?
A. This information may be found on the THIN Web site, (Form is Blue Shield Fax/Mail EMC Documentation), as well as in the First Quarter 2003 BlueReview.
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Q. Will I still get a Provider Claim Summary (PCS) even if I elect to receive payment electronically?
A. Yes, you will continue to receive Provider Claim Summaries. The "E" in the check number easily identifies that the funds were electronically transferred.
Q. Since software programs needed to be HIPAA compliant by 10/16/2003, are all claims required to be HIPAA compliant?
A. THIN is still accepting claims even if they are not HIPAA compliant. THIN is in the process of contacting Vendors and Submitters to encourage compliance as quickly as possible.
Q. What is the difference between THIN EDI and ECARE?
A. You submit your claims electronically through THIN EDI; use ECare to access THIN on-line inquiry.
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Q. Can we get the claim number from our acceptance report for claims filed through THIN?
A. The first report received from THIN will not include the payer’s claim number. However, the second level reporting from the payer, generally sent three to four business days after the initial THIN acceptance report, includes an Internal Control Number (ICN). For BCBSTX PPO, POS and Indemnity claims, the ICN is the BCBSTX claim number. Although you will also receive an ICN number for HMO Blue Texas claims, this is not the claim number.
Q. Can a claim go through THIN without alpha prefix?
A. You may submit your claim to THIN, who will try to locate a membership record. If, however, a membership record cannot be found, the claim will be returned to you. BCBSTX recommends that you contact the appropriate Customer Service Department, found on the back of the member’s ID card, to obtain the correct alpha prefix for that date of service or obtain alternate claim filing instructions in the absence of the three digit alpha prefix.
Q. Who is responsible for claim edits?
A. THIN establishes edits based on HIPAA compliance requirements and payer claim processing requirements. This process allows you to correct and re-transmit rejected claims immediately, to avoid unnecessary delays. Software vendors may have edits in their software programs to ensure some level of completeness prior to transmission of claims to the clearinghouse/payer. It is very important for you to review your response files for warning and reject messages. If the message is a "Warning," the claim has been forwarded to the payer; however you should attempt to correct the error prior to your next submission. If the message is a "Reject," the claim WAS NOT forwarded to the payer; you should correct the error and resubmit that claim in your next transmission.
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Q. How long does it take to get registered for THIN? How are we notified?
A. Registration takes about 14 days. Notification is via fax, and will contain your ID for immediate use. You may review the enrollment procedures on the THIN Web site.
Q. I have a claim that keeps getting rejected. What should I do?
A. Review the THIN and/or payer reports to determine the root cause. You should also verify that all required data fields are populated and accurate. You may also contact the THIN EDI Help line at 877-334-8446 for assistance.
Q. What if a new CPT, ICD9, diagnosis code or modifier was created? How do we know if THIN accepts the code/modifier? Will it reject?
A. All valid CPT, ICD9, diagnosis codes and modifiers may be submitted. Problems should be reported to the THIN EDI help desk at 877-334-8446.
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Q. Can we file secondary claims electronically?
A. Yes. Enter the primary carrier’s paid amount in the appropriate field. Information may be found on the THIN Web site at www.thinedi.com or you may contact the THIN EDI Helpline at 877-334-8446.
Q. Does software have to be from one of the Vendor partners?
A. The vendor partner list is available to obtain information regarding our current partners. However, there is no requirement to use a THIN vendor partner. Each provider may select the vendor of their choice.
Q. What are receiver types?
A. THIN electronic information. G=HMO, F-Commercial, etc. Additional information can be located on the THIN Web site.
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Q. If a carrier number is not on the payer list, can the claim still be sent electronically to THIN?
A. Contract the THIN EDI Helpline at 877-334-5480 for assistance. If there is an existing connection already in place, the payer representative can add that payer on the same day, allowing the provider to submit his claim later that day.
Q. It is my understanding that THIN is generally a free service.
A. The majority of services provided by THIN are at no charge. Certain services (e.g. THIN App) do require a nominal fee. Please keep in mind that some other Vendor services may require a fee.
Q. Is there a fee if you have two submitter numbers?
A. There is no fee to use THIN as long as the provider submits the majority of their claims electronically.
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Q. Are there any problems matching faxed documentation?
A. BCBSTX has taken additional steps to improve this process. Should you experience any problems going forward, please notify us immediately so we may investigate.
Q. What should I do if the patient names are not on the r-EDI link reports?
A. Make a request to your vendor for the information.
Q. Who do we contact regarding report data? We find there is sufficient information for Medicare and Medicaid, but not for BCBSTX.
A. Contact your Provider Automation Representative or the THIN EDI Helpline at 877-334-8446 for assistance.
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Q. Do the THIN reports include paper claims?
A. Yes, but only if your electronic submission is processed through THIN App and results in a paper claim being developed and mailed on your behalf. THIN cannot and does not track paper claims submitted directly by the provider.
Q. What is normal response time we should expect from THIN for our electronic claims submissions?
A. The initial ATHIN acceptance or reject report is generally provided within 24 hours. That is your first response. The payer’s response should be received within three to four business days. Of course, all payers are different and the timeframe may vary somewhat It is extremely important that you review both your initial response and the payers response to verify your claim has been received and accepted for processing. NOTE: Reports are often sent to the submitter. Check with your Vendor if you are not receiving all your reports.
Q. Can a duplicate electronic claim be filed after 31 days?
A. Yes, However, this claim would not be considered “clean” pursuant to SB418 guidelines. Claims must be filed with a “D” in box 10d on the CMS 1500 claim form and that cannot be done electronically at this time.
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Q. We submit claims electronically, but they are being denied with an edit of anything over $10,000 must be sent on paper. Are you aware of this?
A. This is not a THIN edit. THIN recommends you check your software edits and/or check with your vendor to resolve.
Q. What is the received date from the clearinghouse?
A. The received date is based upon when THIN accepts the claim. The payers received date is based upon when the payer received the claim from THIN.
Q. With THIN eligibility do you get a confirmation number?
A. No, a confirmation number is not provided at this time. However, you may print the information.
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Q. An FEP subscriber number does not include an alpha prefix. Should these claims be filed electronically?
A. The FEP subscriber numbers consists of the letter “R” followed by nine numeric digits. This is what the provider should be using when filing electronic claims.
Q. What’s the post marked date for when they submit thru THIN App?
A. Claims are generally postmarked within three to four business days from THIN’s receipt of the electronic submission.
Q. Is there a fee for THIN App paper claims to be forwarded to the paper?
A. Yes. The fee is currently equivalent to first class postage.
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Q. What are the prompt pay limitations for duplicate claim filings?
A. Duplicate electronic claims should not be filed before the 31st day after the original submission. Paper claims should not be filed prior to the 46th day after the original submission.
Q. We often receive a busy signal when attempting to transmit on Saturdays. Do you know if other providers have the same problem?
A. THIN EDI is available seven days a week. THIN suggests you check your software and configurations. If that is not successful, please contact the THIN EDI Help Line at 877-334-8446.
Q. Who pays THIN?
A. In most cases, Payers pay THIN.
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Q. Can the provider view the THIN reports their billing company receives?
A. All reports are supplied directly to the submitter. If you are using a billing service or other party as the submitter, you would need to contact them for the reports you require.
Q. When providers first get set-up on EMC, who assists with training?
A. the Vendor will provide the initial training. THIN is available for problem resolution.
Q. When sending EMC notes, does the provider have to put the symbol in there?
A. It is not required by THIN, but is necessary in order for the carrier to recognize additional information has been forwarded and the method in which it was submitted.
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Q. What is the difference between THIN and WebMD?
A. They are two different clearinghouses.
Q. Is an Electronic Remittance Notice the same as an Electronic Provider Claim Summary?
A. No. The Electronic Remittance Notice includes some of the information found on the Provider Claim Summary, but it is not an exact duplicate or in the same format.
Q. Can we get a rejected posted report?
A. Yes, if the flat file is available.
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Q. Is the rejected flat file on the weekly report?
A. Yes
Q. BCBSTX accepted the claim, but then rejected it for a membership error. What should the provider do?
A. Most of the time when THIN accepts the claim and the payer rejects it for no membership, it is because the alpha prefix was invalid or not on the claim. It is very important to be sure that the correct alpha prefix for the date of service being billed is included on the claim.
Q. On occasion we will contact Provider Customer Service and be directed to contact THIN. Why can’t the provider call one number?
A. BCBSTX is evaluating additional training for our Provider Customer Service Representatives to be able to assist you with more information regarding your electronic inquiries where possible.
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