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Blue Cross and Blue Shield of Kansas Update All Payers Workshop December 5, 2014 Presented by Sally Stevens.

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Presentation on theme: "Blue Cross and Blue Shield of Kansas Update All Payers Workshop December 5, 2014 Presented by Sally Stevens."— Presentation transcript:

1 Blue Cross and Blue Shield of Kansas Update All Payers Workshop December 5, 2014 Presented by Sally Stevens

2 Kansas Solutions A new BCBSKS subsidiary Effective January 1, 2015 Limited network – BCBSKS' 103-county service area only! Excludes Johnson & Wyandotte Counties in KS Represented by an empty suitcase Sold to individuals on and off the exchange and small group (SHOP) markets Claims for Solutions members will have its own remittance advice (RA)

3 Kansas Solutions Blue Solutions is not a traditional HMO: –Members will NOT choose a Primary Care Provider (PCP) –No referral is needed for visiting a specialty provider –Members have open access through the BCBSKS Blue Choice network –Providers reimbursed using Blue Choice payment rates

4 Kansas Solutions

5 The following alpha prefixes will be used for Kansas Solutions members: XSC - Individual Exchange Solutions XSG - SHOP Exchange Solutions XSQ - Individual Solutions Off-Exchange XSR - Small Group Solutions Off-Exchange

6 Kansas Solutions

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8 Affordable Care Act (ACA) Grace Period ACA mandates a three-month grace period for individual members who: –receive a premium subsidy –have paid at least one month's premium –are delinquent in paying their portion of premiums

9 Affordable Care Act (ACA) Grace Period BCBSKS will: –pay the claims with a date of service in the first month of being delinquent –pend the claims with a date of service in the second and third month of being delinquent –providers will a receive a letter when claims are pending

10 Affordable Care Act (ACA) Grace Period Providers cannot bill the patient during the three-month grace period. Provider can bill the patient once they have received a remittance advice advising the adjudication of the claim. If the patient purchases coverage through the Marketplace again and they meet the ACA grace period mandate, the patient can have coverage again and not have to remit payment for the previous delinquent dues. Availity will display delinquent information for month two and three beginning January 1, 2015.

11 ICD-10 Testing Two types of testing: 1.Acknowledgement testing: Healthcare payer confirms that a test claim can be accepted, but doesn't test how it will be reimbursed. 2.End-to-End testing: Healthcare payers will submit a test claim through the payers claim adjudication system and report the reimbursement to the provider.

12 ICD-10 Testing Acknowledgement testing is testing with the provider's vendor/clearinghouse etc.; not the payer. –ICD-10 test claim is created –Test claim is transmitted to your clearinghouse or ASK –Front-end edits, including validation of ICD-10 code set, will be applied –Acknowledgments (999 and 277CA) will be generated –No test 835 will be returned

13 ICD-10 Testing End-to-End testing is testing with the payer Testing begins February 2015 Providers need to request set-up in the test system –ICD-10 test claim is created –Test claim data is submitted to BCBSKS via a spreadsheet –Test claim is transmitted to your clearinghouse or ASK –Front-end edits, including validation of ICD-10 code set, will be applied –Acknowledgments (999 and 277CA) will be generated –Test 835 will be returned

14 ICD-10 Testing Providers testing could see unexpected rejections Testing benefits you and the payers Final thoughts on ICD-10 Testing: –budget for and expect delays –review acknowledgements and utilize claim status resources –www.ask-edi.comwww.ask-edi.com –http://www.bcbsks.com/CustomerService/Pro viders/icd-10/index.htmhttp://www.bcbsks.com/CustomerService/Pro viders/icd-10/index.htm

15 Corrected Claims Increases administrative expenses Slows down payment turnaround Reasons for filing a corrected claim: –billing late charges (lab, physical therapy, drugs, anesthesia, recovery room, Operating Room services) –combining outpatient services onto an inpatient claim –add additional diagnosis code or a modifier Work to find ways within your hospital to ensure that all the charges are on the initial claim. REDUCING CLAIMS IS A WIN FOR EVERYONE!

16 Blue Cross and Blue Shield of Kansas Update Thank you for your time today! Questions?


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