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Announcing Changes that Will Affect Claims Submissions for Medicare Advantage Plans

September 30, 2016

Effective January 1, 2017, Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM will have changes that will affect claims submissions for our Medicare Advantage Plans. These changes will assist in streamlining claims processing and improve efficiencies of claims routing to our primary claims adjudicator.

The changes include the following:

  • New Payer ID for Blue Cross Medicare Advantage plans
    • The Payer ID for the Blue Cross Medicare Advantage plans will change to 66006 for claims submitted on and after January 1, 2017. Providers that are not registered with Availity, and Passport/NEBO (ecare online) should contact their clearinghouse to confirm the new Payer ID for this plan — as other clearinghouses may assign their own unique number.

      Please note that the Blue Cross Medicare Advantage member ID cards will contain the following applicable state member ID number alpha prefixes:

      StatePPOHMO
      Texas ZGD ZGJ
      Illinois XOD XOJ
      New Mexico YID YIJ
      Oklahoma YUX YUB
      Montana YDL YDJ


      The new payer ID 66006, should be used for submission of electronic claims for any Medicare Advantage members from the states referenced above. You will no longer use the commercial payer IDs for claims for Medicare Advantage members from those states with member ID number prefixes listed above. Claims for members with those ID number prefixes that are not submitted to payer ID 66006, on or after January 1, 2017, will be rejected and the reason for the rejection will be included.
  • EFT Payment Cycle
    • Payment cycles for EFT will be changing from daily to weekly. Blue Cross and Blue Shield will make weekly EFT payments for Medicare Advantage Plans effective 1/1/2017.
  • Paper claim mailbox address for non-delegated providers (no changes for RPO/EPIC/VOP providers)
    • Paper claim mailbox address and fax number for non-delegated providers will change to:
      Blue Cross Medicare Advantage
      P.O. Box 3686
      Scranton, Pa. 18505
      Fax Number: (855) 674-9192
  • New processes
    • New format for EFT and paper checks is expected, details will be shared in future communications.
    • A new process will be implemented for claims overpayment recovery. All letters, remittance advisers, vouchers, lockbox and provider manual details will be updated with future communications.
  • Electronic Remittance Advice (835 ERA)
    • 835 ERA files will be distributed to the address associated with the billing provider’s Tax ID, rather than being distributed to multiple locations.

BCBSTX will be providing additional information regarding these changes in the coming months on the BCBSTX provider website at bcbstx.com/provider and in the Blue Review provider newsletter.

Member eligibility and benefits should be checked prior to every scheduled appointment. Eligibility and benefit quotes include membership status, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. It is strongly recommended that providers ask to see the member's ID card for current information and a photo ID to guard against medical identity theft. When services may not be covered, members should be notified that they may be billed directly.

If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.