Reminder: Important Changes Impacting Claims Submissions for BCBSTX Medicare Advantage Plans Effective Jan. 1, 2017

On December 7, 2016, Blue Cross and Blue Shield of Texas (BCBSTX) provided a preview of changes that became effective Jan. 1, 2017, as part of an initiative to improve efficiencies in claim-related processes for Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM member claims. This is a reminder of the changes that are now in effect.

The following information applies
to BLUE CROSS MEDICARE ADVANTAGE (PPO)SM
& BLUE CROSS MEDICARE ADVANTAGE (HMO)SM

Electronic Payer ID
(for claims received as of Jan. 1, 2017)

New Payer ID-66006

Effective Jan. 1, 2017, Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims received must be submitted with PAYER ID 66006. Providers should no longer use commercial Payer ID 84980 for Blue Cross Medicare Advantage Plans. If you use a practice management/hospital information system or billing service, and/or a clearinghouse other than Availity or Passport/Experian for electronic claim submission, contact your vendor to confirm they are using the new Payer ID 66006.

Blue Cross Medicare Advantage PPO and HMO Member ID Number Prefixes


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


Claims with the above member ID number alpha prefixes must be submitted using the new Payer ID 66006, even for members who seek services from you when out-of-state.You will no longer use the commercial payer IDs for out-of-state members with these prefixes. Claims with these prefixes will be rejected if submitted to the commercial payer ID.

Electronic Eligibility and Benefits via AvailityTM
(for services rendered on or after Jan. 1, 2017)

New Blue Cross Medicare Advantage option in dropdown menu on Availity Web portal for registered users.

Paper Claim Submission – Mailing Address for Non-Delegated Providers*
*Effective Feb. 1, 2017, claims received at the old mailbox will be rejected with a letter informing providers to resubmit to the correct mailbox.

New mailing and fax information for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims:

Blue Cross Medicare Advantage
c/o Provider Services
P.O. Box 3686
Scranton, PA 18505

Claim Payment Cycles and New Format for Electronic Funds Transfer (EFT)

Effective Jan. 1, 2017, Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claim payments will be made on a weekly basis instead of daily.

On electronic payments for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims, the EFT trace number will start with a source code of “M” instead of “C.”

Electronic Claim Status

Submit electronic claim status inquiries (HIPAA 276 transactions) through Availity or your preferred vendor portal. Effective Jan. 1, 2017, the Claim Research Tool on the Availity Web Portal will no longer be available for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.

Electronic Remittance and Provider Claim Summary (PCS)

• 835 Electronic Remittance Advice (ERA) files for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) will be distributed to the address/Receiver ID associated with the billing provider’s Tax ID, rather than being distributed to multiple locations/receivers.

• The Electronic Payment Summary (EPS) from BCBSTX will no longer be sent with the 835 ERA for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO).

Effective Jan. 1, 2017, paper PCSs will be sent by mail for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims to ERA and non-ERA receivers.

• The electronic Payer ID on the 835 ERA will now match the Payer ID that is submitted on the claim. (Effective Jan. 1, 2017, the new Payer ID is 66006 for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.)

For current 835 ERA receivers, there is no need to re-enroll to continue receiving electronic remittance information for Blue Cross Medicare Advantage claims.

Overpayment Recovery

Effective Jan. 1, 2017, a new process will be implemented for claims overpayment recovery.
  • The Electronic Refund Management and Claim Inquiry Resolution tools on Availity will no longer be available for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.
  • Request for refund letters will be sent by mail for all providers.
  • Beginning Jan. 1, 2017, providers may submit requested and voluntary refunds to the following address:
Blue Cross Medicare Advantage
c/o Provider Services
P.O. Box 3686
Scranton, Pa. 18505

FOR MORE INFORMATION

We appreciate your patience during this transition. As of Jan. 1, 2017, Provider Manuals, 835 ERA/EFT Companion Guides and other resources will be updated. These changes will be noted on the website and in the provider manuals accordingly. Please continue to watch for further information on the BCBSTX website at bcbstx.com/provider and in the Blue Review provider newsletter. If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.

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.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. Passport/Experian is an independent third party vendor and is solely responsible for its products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by Availity or Passport/Experian. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.