| 837 Health Care Claims Questions |
| Q. |
When will you be ready to accept the HIPAA 837 (Healthcare Claims)? |
| A. |
We will be ready to accept professional, institutional and professional 837 transactions on October 16, 2003.
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| Q. |
Are you able to accept test 837 claims? |
| A. |
Yes. You must complete the appropriate Trading Partner Agreement and Enrollment form. There is one for hospitals and healthcare professionals, and another for clearinghouses.
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| Q. |
Do you require the taxonomy code to be reported on any of the 837 formats, and, if so, which ones?
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| A. |
No. The addenda version removed this as a requirement. We will accept taxonomy; however, it is not a required field.
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| Q. |
If applicable, are you going to continue to accept "J" codes? |
| A. |
Yes.
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| Q. |
Are there any circumstances where you might require providers to use NDC codes on the 837? |
| A. |
Yes, unclassified codes should be submitted with the NDC number.
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| Q. |
Will you be able to accept 999 claim lines? |
| A. |
Yes.
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| Q. |
Do you allow zero charges on claims? (Page 159 of the 837 Implementation Guide) |
| A. |
Yes.
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| Q. |
Do you allow negative charges on claims? |
| A. |
No.
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| Q. |
Will you require a secondary identification number and, if so, what? (Pages 82 and 97) |
| A. |
We need to receive either a 1A or 1B code qualifier, which is the BlueCross Provider Number. This number is the Tax Identification Number -- with or without a 3-digit suffix that identifies locations. We provided the 3-digit suffix to the providers during the provider certification process.
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| Q. |
When receiving claims in a batch mode, if one claim contains an error will just that claim reject or will you reject the entire batch?
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| A. |
We perform edits at the batch level. So if there is a problem with one claim, we will return the entire batch. |
| Q. |
What is your payer secondary identification qualifier and reference identification? |
| A. |
Following are the NAIC and carrier codes.
NAIC Codes
38520: BlueCross BlueShield of South Carolina
95741: BlueChoice HealthPlan
Carrier Codes
400: BlueCross BlueShield State Health Plan
401: Blue CrossBlue Shield
402: FEP BlueCross
922: BlueChoice® HealthPlan
The following carrier codes are for those TPAs that use the Preferred Blue® network and are also accepted electronically. The carrier code is used to route these claims to the appropriate area. So it is imperative to use the appropriate carrier code for TPA members' claims.
886: Planned Administrators, Inc. (PAI)
315: Thomas Cooper
130: Employers Life Insurance Company
446: Employee Benefit Services dba Key Benefit Admin.
498: Carolina Benefit Administrators (CBA)
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| Q. |
Do you require Patient Secondary ID#? (Page 153) |
| A. |
We do not currently require a secondary patient identifier.
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| Q. |
Do you require contract information? (Page 176) |
| A. |
No.
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| Q. |
Will you require submitters to report Payer Estimated Amount Due? (Page 178) |
| A. |
No.
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| Q. |
Will you require submitters to report Patient Estimated Amount Due? (Page 180)
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| A. |
No.
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| Q. |
Will you require submitters to report Patient Paid Amount? (Page 182) |
| A. |
No.
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| Q. |
Regarding legacy claims (claims which must be rebilled or filed for dates of service prior to October 16), are you requiring the provider to use the HIPAA non-medical codes or will you accept non-medical codes in effect prior to October 16? |
| A. |
On the 837 format, the non-medical code sets must be HIPAA compliant regardless of the date. The medical code sets are being edited with a date of service date as the key (i.e. local codes will be accepted for dates of service prior to 10/16/2003).
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| Q. |
Do you have a contingency plan? If yes, does it consider providers switching to paper claims, interim payments or acceptance of non-compliant claims?
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| A. |
Yes. Read about our contingency plan here. We also have claims submission capabilities via the Web site that is available to all providers in the state.
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| Q. |
With regard to Release of Information CLM09 and OI06, in your opinion is an "N" a legitimate code based on the Implementation Guide and Privacy regulations? (i.e., will you accept "l?") (Page 161)
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| A. |
Based on privacy guidelines, it does not seem appropriate for a provider to file with an "N." Our Supplemental Implementation Guides, however, will allow any valid value.
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Read more frequently asked questions.
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