April 8, 2019
The notice applies to providers submitting electronic claims for the following Blue Cross and Blue Shield of Texas (BCBSTX) members:
- Blue Cross Medicare Advantage (HMO)SM
- Blue Cross Medicare Advantage (PPO)SM
Effective April 11, 2019, payer response reports for the above-referenced electronic government programs claims will identify invalid National Drug Codes (NDCs) that are causing the claim to reject. Submitters will continue to receive:
- Health Care Claim Status Category Status Code A8: Acknowledgement/Rejected for relational field in error; and
- Health Care Claim Status Code 218: NDC number.
The 277CA – Health Care Claim Acknowledgement will now include the invalid NDC that caused the claim to reject in data element 2200D, STC12. This will help you quickly identify and correct the invalid NDC that is causing the claim to reject. All NDCs present are compared against the Medi-Span® NDC list and must be active relative to the Date of Service (DOS) on the service line. If they are not, the claim will reject. If the claim was a paper submission, you will receive a letter from BCBSTX notifying you of the claim rejection. After making the appropriate correction, you may immediately resubmit the claim electronically to help avoid processing/payment delays.
Please share this notice with your practice management/hospital information system software vendor, billing service or clearinghouse, if applicable, to help ensure they will be able to process/display the additional data element (2200D, STC12). Providers who utilize Availity® services for electronic claim submission do not need to confirm this process with them, as Availity will display this additional data element in their payer response reports.
If you have any questions, please contact your assigned Provider Network Representative.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. Medi-Span is a trademark of the Health division of Wolters Kluwer, an independent third-party vendor that is a leading global provider of information and point of care solutions for the health care industry. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity or Wolters Kluwer. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.