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. Kansas Solutions
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

7. Kansas Solutions

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:
Acknowledgement testing: Healthcare payer confirms that a test claim can be accepted, but doesn't test how it will be reimbursed.
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

15. Reducing claims is a win for everyone!
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?