New ID Numbers are
here
| Why did Regence BCBSO change from Social
Security Numbers (SSNs) to new ID numbers? |
We have changed to new ID numbers in response
to employees' and customers' requests for protection
from identity theft and preservation of their health
information privacy. Legislation in California and
other states that restrict the use of SSNs also
was considered. |
| When did this take place? |
We assigned and began using new ID numbers in
December, 2004. ID cards were printed and mailed
beginning in December and continued through the
first quarter of 2005. |
| Did the ID Number format change? |
Regence BCBSO will continue to use a three three
letter alpha prefix with a nine-digit ID number
for a total of twelve characters. New ID numbers
will range from
920000000 – 949999999. |
| How does this affect Coordination of Benefits
(COB) when we exchange information? |
All printed materials now display the new ID numbers.
Our systems link SSNs if submitted to new ID number
for claims processing. This allows us to communicate
with the other carrier to coordinate payment of
claims. |
| Does each member of the family have a
different ID number? |
No, only one ID number is assigned to the subscriber.
Covered family members share ID cards, and have
the same ID number as the subscriber. |
| If a member forgets their card, will we
be able to access their benefit information if the
member does not know their new ID number? |
Yes, a member can use their SSN or new ID number
to communicate with us or at the provider's office.
Our systems will link the records and continue to
encourage providers, members and others to use new
ID numbers. |
| Does Regence Online Services recognize
a SSN if we don't have the new ID number? |
Yes, Regence Online Services accepts either the
SSN or the new ID number when searching for the
patient, however only the new ID number displays
in the online system screens. |
| Are there changes to EMC claims edits
or reports as a result of the new ID numbers? If
yes, what are the changes? |
There are no changes being made to edits. Provider
reports display only the new ID numbers. |
| Do Availity, LLC reports continue to print as they
do today (i.e., Availity, LLC edit reports print with the
submitted SSN)? |
Yes. We did not implement any changes to Availity, LLC
reports. |
| Does the member's Medicare number continue
to display on reports for Medicare cross-over claims?
|
The SUB ID field will not change on reports. Our
eligibility systems will continue to store SSN and
Medicare numbers, including HIC numbers. |
Billing
When I bill with a CPT procedure code and include
a modifier, it does not show on our vouchers that the
modifier was considered. Why?
Because the modifiers do not appear on the claim voucher,
it may appear that we have not considered the specific
modifier you billed. Most modifiers are considered at
the time of claim processing to be subject to our reimbursement
policies, although not all modifiers affect the processing
of a claim.
Medicare
- Why are claim payments for my Medicare supplemental
(secondary to Medicare) patients sometimes sent directly
to the member when Medicare has paid us directly for
their portion?
When claims are sent to us from Medicare Part A or
B and the Medicare provider number on our file does
not match the Medicare provider number submitted by
the intermediary, we pay the member. If this continues
to be a problem for your office, please contact your
provider relations representative to verify the Medicare
number on our files is current and correct. Most times,
this will resolve the issue.
- What happens to our Medicare claims if our office
does not participate with the Medicare crossover program,
but our patient participates in the Medicare crossover
program?
If your office does not participate in the Medicare
crossover program, you will not have a Medicare provider
number loaded on our file. If you send the claim to
Medicare, a message will appear on your voucher not
to bill Regence BCBSO electronically. Our subscriber
will receive Regence BCBSO supplemental payment(s)
directly.
If your office continues to have issues with Medicare
crossover claims, please contact your provider relations
representative directly or call Provider Customer
Service at (503) 225-6619 or 1 (800) 722-5086 to
verify your Medicare provider number.
Oregon's Prompt
Payment Law
Why don't you pay interest on BlueCard claims
under Oregon's prompt payment law?
Oregon Insurance Code does not apply to insurance policies
delivered or issued for delivery outside the State of
Oregon. Therefore, if someone is in Oregon receiving
services under a policy that was issued in another state,
the claims are not subject to Oregon prompt payment.
For Regence BCBSO members receiving services in another
state, the law only pertains to providers licensed or
permitted to provide medical services under Oregon State
law. Out-of-state providers do not apply in this instance,
so those claims are excluded too.
What is the difference
between a provider relations representative and a provider
consultant?
Regence BCBSO has provider relations representatives
and provider consultants in the Provider Affairs division
available to assist your office. Provider relations
representatives and provider consultants are assigned
based on geographic territory and by large clinic or
hospital and work together to provide you the best possible
service.
Your assigned provider relations representative is
your main point of contact for questions regarding billing,
coding, agreement terms and demographic changes. Contact
your provider relations representative for:
- New office orientations
- Provider agreement terms
- Explanation of specific medical, reimbursement or
administrative policies
- Callshare issues
- Billing and coding
- Requests for Regence BCBSO Participating and Preferred
agreements
- Demographic changes (e.g., address or tax identification
number changes)
- Complaints and grievances
- Inquiries that cannot be resolved through Customer
Service
Your assigned provider consultant is your primary external
contact and works to resolve global issues rather than
specific transactions. Contact your provider consultant
for:
- Office visits for problem solving
- Office manager meeting participation
- Resolution of global issues, e.g., policies, medical
review
- Operational interface between organized groups and
the health plan
- Delegation issues
- Training and information on electronic tools, e.g.,
Regence Online Services for physicians and providers
- Information on Regence BCBSO strategic initiatives
Contact your provider
relations representative or provider
consultant.
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