HCR News Jan 2014-2.indd - Blue Cross and Blue Shield of Louisiana
Contents
1. Facility CPT only copyright 2014 American Medical Association All rights reserved LJ BLUE HEALTH RECORDS A is a patient s complete claims health record CHR history of current and past prescriptions filled illnesses and associated treatments surgeries performed immunizations and preventive healthcare received within the last two years These records are useful for treating new patients as well as patients with complex health issues and chronic diseases Facilities can also benefit from the use of Blue Health Records when treating emergency room patients We do require that providers limit access to this sensitive information and recommend that only physicians and designees of physicians responsible for patient care request access to the Blue Health Record iLinkBLUE users must complete our iLinkKBLUE System CHR Access Security Form For more information email ilinkblue providerinfo bcbsla com gt Coverage Information To access a patient s Blue Health Record click on the E screen under the Coverage Summary Coverage Information menu option Enter the member s contract number then click the Eligibility DE Contract Benets submit button The screen will expand to show the member and dependent eligibility FEP Benefits and Eligibility information Under the Member Health Information is where the Blue Health Record link is found for each member on the policy Eligibility Information Member Health Inform2. would prefer to research multiple allowables enter only the first few numbers followed by an asterisk See chart at right DID YOU KNOW Dentists allowable charges are shown on iLinkBLUE for dental codes when the Key Dental Network is selected in the network drop down box Complete listing s of services that require authorization are available in the following manuals and speed guides Available online at e Member Provider Policy amp Procedure Manual www bcbsla com providers e Professional Provider Office Manual e BlueConnect Speed Guide gt Education on Demand Professional Provider e Community Blue Speed Guide Office Manual e HMOLA Provider Speed Guide Member Provider Policy amp Procedure e Office of Group Benefits OGB Speed Guide Manual is available only under the Manuals e Preferred Care PPO Speed Guide link on iLinkBLUE e Premier Blue Speed Guide The authorization process ensures that members receive the highest level of benefits to Teeucuu iieyrae e which they are entitled and that the most appropriate setting and level of care for a given Outpatient Authorizations medical condition are provided Authorization requirements may vary slightly by product Providers should initiate the authorization process at least 48 hours prior to the service being rendered You can research and view and even submit some authorization requests from iLinkBLUE using the Authorizations menu option e With the Inp
3. provider Cr New Rules New Challenges NeW Opportunities Contract Search Coverage Information w Claims Entry Claims Research w Medical Policy Coverage Guidelines Pre Authorization Pre Certification Information Medical Code Editing Estimated Treatment Cost is the Provider Suite Blue Cross and Blue Shield of Louisiana s iLinkBLUE Provider Suite is our secure online tool for facility and professional healthcare providers It is designed to help you quickly complete important functions such as eligibility and coverage verification claims filing and review and payment queries and transactions With iLinkBLUE providers have access to features such as e coverage information e claims entry e claims research e allowable charges e authorizations e remittance advice electronic funds transfer EFT BlueCard out of area network e manuals medical policies medical code editing estimated treatment costs e and MORE iLinkBLUE is FREE of charge for ALL providers To gain access to iLinkBLUE you must complete the appropriate iLinkBLUE agreement packet The iLinkBLUE provider agreement packets are available online at www bcbsla com providers gt Electronic Services gt iLinkBLUE e Professional Provider Agreement Packet e Institutional Provider Agreement Packet e Billing Collection Agency Agreement Packet Each packet includes a Business Associ
4. Check Information Claims Tracking rejected and pended claims Providers can view claims detail pages that display the e The Claims Status page provides information on Blue Cross and HMOLA paid amounts applied toward the deductible ineligible amounts or coinsurance amount for a specific claim When you choose to view pended claims an additional menu will prompt you to select a line of business All Federal ITS BlueCard Reg BC Supplemental category When All is selected you will be able to view all pended claims on file On each claim providers have the option to submit an Action Request when they have questions or concerns about the claim e The ITS Out of Area Claims screen provides the same claims information as the Claims Status page but for BlueCard out of area members only e The Action Request Inquiry screen allows you to view Action Requests submitted on any pended processed or rejected claims You may only view Action Requests submitted for your provider e After a claim is processed a check usually an electronic payment is issued when a payment is due Once the payment is issued the specifics of the payment information are displayed on the Check Information screen e The Claims Tracking area displays claims that cannot be located in pended or processed claims and or any applicable pre admission certification information Blue Cross does not want our providers taking risks when it comes to a
5. 2013 INJECTION TREATMENT OF NOSE Allow 99213 12 15 2013 OFFICE OUTPATIENT VISIT EST 25 __Disallow 99001 42 15 2013 SPECIMEN HANDLING PT LAB l Current Claim CPT only copyright 2014 American Medical Association All rights reserved One of the tools available to our Preferred Care PPO members is the Estimated bEcamated Treatment Cos Treatment Cost Tool With this tool members can view information about the View Reports value you bring to the healthcare community and are enabled to be more active in Reconsideration Form Cost Data Methodology managing their own healthcare choices The tool features the costs and volumes FAQs associated with 402 elective planned procedures which include 45 new treatment Treatment Codes Listing categories as of Fall 2013 These new treatment categories include 35 new inpatient outpatient and diagnostic treatment categories and 10 new office visit treatment categories This service will expand to include our HMO Louisiana Inc HMO members in the future Where does the cost data come from It is a provider specific estimate of cost ranges for an episode of care Cost estimates are developed using 12 months of claims data for inpatient outpatient and diagnostic and six months of claims data for office visits The facility data is modeled re priced to represent the most current contract as of the time of processing For INPATIENT treatment For OUTPATIENT
6. Alpha Prefix CLEAR CLAIM CONNECTION The Medical Code Editing menu option is home to the Medical Code Editing Gear Gaim Connechon Clear Claim Connection C3 tool C3 is an easy to use Web based code auditing reference tool designed to audit and evaluate code combinations C3 is a self service inquiry tool to help reduce manual inquiries and time consuming appeals C3 also indicates whether or not a CPT Modifier and or CPT Modifier combination is valid for the date of service entered on the inquiry After clicking on Clear Claim Connection you must accept the terms and conditions Note Be sure to disable your pop up blocker when using this tool You are then routed to a web based tool administered by McKesson Corporation The first screen you encounter is the Claim Entry screen You will need to enter the patient s gender and date of birth procedure codes date of service and any applicable modifiers You may enter up to 10 procedure codes per query Example 1 The patient is a male born January 1 2000 and the provider performed two procedure codes 99203 and 30200 on December 15 2013 Claim Entry After entering the patient s information and codes click the Review Claim Audit Results Gender Male Female ooo ee button When the codes are compatible no edit results are generated Date of Service 99203 12 15 2013 Procedure Mod 1 Mod 2 Mod 3 Mod 4 Claim Audit Resu
7. procedure For DIAGNOSTIC service For Professional Office Visits categories inpatient facility categories CPT codes treatment categories the primary CPT codes identify claims for specific DRG identify each treatment technical and professional each treatment category code s are combined with category and all costs components are combined For chiropractic and physical professional diagnostic and that members receive on Costs are aggregated and therapy all costs for the visit other claims for services the day of the procedure estimates are created are summed to create the the patient incurs from are summed up to create for both the facility and estimate the admission through the aggregates and estimates professional provider of the discharge date to arrive at for both the facility and procedure For Other categories total estimates for display professional provider of the weighted average costs procedure per CPT codes create the estimate Twice a year spring and fall Blue Cross refreshes the tool with updated provider cost data When this occurs we send a letter to our providers advising them that they have 30 days from the date of notice to review the cost data and request a reconsideration if needed This process is completed through the iLinkBLUE Estimated Treatment Cost menu option e The View Reports option allows you to view the most recent report that contains the cost ranges calculated for your facility or practic
8. A PERMIT NO 458 An independent licensee of the Blue Cross and Blue Shield Association PO BOX 98029 BATON ROUGE LA 70898 9029 Healthcare Reform New Rules New Challenges New Opportunities Find more online about healthcare reform at www BCBSLA com reform How do buy insurance Reform Web www BCBSLA com reform www LHEC net WHAT PLAN IS RIGHT j Help Me What Are Start i Understand My Options Toone D Ul a gt y er mt ot hran or awe I V ls x Provider Web www BCBSLA com gt l m a Provider iLinkBLUE amp EFT iLinkBLUE Providerlnfo bcbsla com 1 800 216 BLUE 2583 uest Information Provider Relations Provider Relations bcbsla com 1 800 716 2299 option 4 Laam adar heather lom Mihr 2 drr oa tors ch Oowmminad ACA Presentation 4 Downloads cy Videos Network Development Network Administration bcbsla com 1 800 716 2299 option 1 Provider Services 1 800 922 8866
9. MOLA network agreements Also available is the 1500 Claims Entry Manual which can be used in conjunction with filing claims in iLinkKBLUE as outlined on Page 3 of this newsletter The Allowable Charges link houses printable PDF listings for the two most recent Drug Allowable Charge updates including pricing for standard durable medical equipment DME home infusion Oncology Management Program and administration drug codes Also available on this page are the HCPCS allowable charge listings for DME Researching medical policies online is easy with iLinkBLUE Providers can search gt Medical Policy for approved and current medical policies Using the Medical Policy Coverage Coverage Guidelines Guidelines menu option providers may view medical policies for our BCBSLA BCBSLA Out of Area members as wells as BlueCard Out of Area members e Providers can easily research medical policies for BCBSLA members using an index that lists ca BiyeCromBhoeShiel nine acies i pE policies in alphabetical order Each month a orioa e A FDAPLN FINDA DOCTOR ORDRUG ABOUT BLUE A Fra rere a a te atm baaa we add newly approved and or revised Abatacept Orencia Poli Career Centa Company Media Center Bamber Peounces medical policies to iLinkBLUE Because medical technology is constantly evolving Enter Keyword s oO7 Select a Lettar A our medical policies are regularly reviewed often resulting in updates or re
10. ate Agreement that allows Blue Cross to receive and disclose protected health information electronically via iLinkBLUE Each packet also includes an Electronic Funds Transfer EFT Form EFT is required as a part of iLinkBLUE and allows us to have your payments directly deposited into your financial account In this newsletter we explore the many functions of iLinkBLUE so please share this newsletter with your billing staff and those in your office who use iLinkBLUE www BCBSLA com iLinkBLUE i ee HCR News January 2014 www BCBSLA com reform i 18NW2082 R01 14 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service amp Indemnity Company Eq BlueCross BlueShield VAY of Louisiana An independent licensee of the Blue Cross and Blue Shield Association Your Health Our Commitment The ay F j j iLinkBLUE contains a bulletin board feature that appears after you Welcome to first log in This area contains up to the minute posts for upcoming IMPORTANT BLUE CROSS MESSAGES E Indormarlonal BCESLA is soeken ow mema endfapear payment scheduled fer Thurs Jan 2 20h toe events new features system outages holiday notices and other solr bi hucker checks Tip lo hisses LAA D AS PO BENEM ro es EF evo ice uae aon important bulletins Sarion FT S Se Indonmational Phee cir here fet miia nimai about pubri credentabng applicants luppetng decotaniaten calwetk ageecenta demegrapiee upelaten ale
11. atient Authorizations screen providers may research the status of an inpatient authorization by entering the member s contract number Information on your patient is then shown including the status of the authorization This option can also be used to view the status of recertification or requests for extended inpatient days The initial inpatient authorization and the extended authorization will share the same authorization number and be listed on the same report for your patient Inpatient authorization is not a guarantee that benefits will be provided It only certifies that the inpatient hospital setting is or is not medically necessary according to the information presented at the time of preadmission certification Benefits will be determined upon receipt of claims in accordance with conditions and provisions of the subscriber s contract certificate e The Outpatient Authorizations screen enables users to view the status of specific outpatient authorizations by entering the member s contract number or a referral reference number assigned by Blue Cross authorization department when the authorization process is initiated Authorizations for surgical procedures and or diagnostic procedures include services for both the specialist MD and the facility provider The two authorizations are combined into a single transaction E g An authorization for a colonoscopy procedure will display two approved days This means that there is one approval fo
12. ation Click here to see details Contract 123456789 Sim Health Waiting Name JO Sex Relationship fealth OED a ealth submit l eae oe nii PESAT SEN Portability Perio eat John Q Subscriber 01 01 2000 M Subscriber D1 01 2010 01 01 2000 Yiew View Report Srill not an iLinkBLOE user It s never too late to join iLinkBLUE and take advantage of its many perks Use these easy instructions to gain access to iLinkBLUE Complete and return the appropriate iLinkBLUE agreement packet includes the Business Associate Addendum and the Electronic Funds Transfer Application for_your provider location this only needs to be done once per location They are available online at wwv x s gt Electronic Services gt iLinkBLUE 2 After we process your agreement packet you will be notified of your iLinkBLUE Identifier Number 3 Each user for your office should go to w and select New User Click here Enter all appropriate information to create a user name each user must complete this process separately Make a note of your user name 4 Each person that registers will receive a temporary password in the mail via PIN mailer This will be sent to the correspondence address we have on your provider record 5 After you have received your temporary password go to on and click Enter iLB and log on You will then be asked to create a new password BlueCross BlueShield en of Louisiana US POSTAGE PAID BATON ROUGE L
13. dvanced premium tax credit APTC members For this reason we are enhancing the iLinkBLUE Provider Suite to include Premium Grace Period notifications These premium status notifications for BCBSLA s APTC members will be available in multiple places within iLinkBLUE so you can stay abreast of your Blue patients who are in the grace period and the possibility of denied claims for the second and third months For more information on this enhancement view the October issue of HCRNews available online at www bcbsla com providers gt News Out of Area We ve added a new BlueCard feature to iLinkBLUE where you may now Fourave 15 New Medical Record Requests Please visit Medical Record Requests Out Of Area menu to view view BlueCard medical records requests for your BlueCard patients in eae iLinkBLUE by clicking the link on the message board like the one at right or directly from the iLinkBLUE menu under Medical Record Requests Once on the Outstanding Requests page second requests and reopened requests will be highlighted in red and will appear at the top of your outstanding request list A second request is displayed when we have requested records more than one time and have not yet received records from the provider A reopened request is used when we have received medical records from the provider but the records were either incomplete or had incorrect information You may also research the status of your m
14. ed in the iLinkBLUE menu under BlueCard Out of Area Coverage Information Response Claims Research Request Claims Research Response e The Coverage Information Request and Response options are used to submit an electronic request to the member s Blue plan then wait for an electronic response to be delivered Though not immediate out of area results are transmitted usually within less than a minute Click on Coverage Information Request then enter the member s three letter alpha prefix contract number and required patient information fields then press submit You will receive a message stating transmission submitted successfully To view response click on Coverage Information Response then choose the Review New button to view new responses Locate the member s contract number to view and print requested information e The Claims Research Request and Response options allow you to request out of area claims information in the same manner as when requesting coverage information You will need the member s alpha prefix and the contract number Please note that more information such as remittance advices check information and claim numbers on BlueCard claims processed by Blue Cross and Blue Shield of Louisiana is available through iLinkBLUE s Claims Research option MANUALS When you click on the Manuals option on the iLinkBLUE menu you will find much more Claims Inquiry than manuals BlueCard Clear Claim
15. edical records on the Requests Completed By Provider and Requests Received by BCBSLA screens When sending medical records to Blue Cross please be sure to print and include the Outstanding Requests detail page specific to the patient for whom you are sending us records The Outstanding Requests detail page includes information such as your provider number and name patient name and date of birth date of service claim number and an address for where to send the medical records ALLOWABLE CHARGES for Professional and Dental Services With iLinkBLUE you can look up your professional allowable rofessional Provider Allowable Charges pe charges by network date of service and individual or multiple codes Click on the Allowable Charges option on the iLinkBLUE Sato aa ee menu You will be prompted to enter a date of service This is important because providers can search current past or future when available allowables Once you ve entered a date of Network 02 Preferred Care PPO lt service click the Continue button You must then enter the CPT Code T E P appropriate network and code Modifiers and site of service kiaiii aa ETE ENEE R codes are optional Once you ve entered your information E A EME EE er R press submit to obtain the allowable charge for the desired date of service and code Please note that if you have a pop up blocker you will need to turn it off for this function If you
16. horizations visit www bcbsla com providers gt Imaging Authorizations WHAT is the STATUS of your OPTINET ASSESSMENT All network providers who provide imaging services are required to complete an assessment through OptiNet and are required to maintain an 80 percent performance score on each modality performed This includes hospitals freestanding diagnostic centers and physician clinics The information we gather is used to understand the quality of radiology services and or future network programs Once in iLinkBLUE click on the American Specialty Health AIM link under Authorizations Once in AIM s ProviderPortal click on Access Your Optinet Registration on AIM s left menu then click the green Access Your Optinet Registration button OptiNet allows you to complete the assessment online Remember to keep your information updated before it expires as this affects your score Under the Confirmation Reports menu option on iLinkBLUE you can access daily reports that we generate to confirm claims that were accepted or not accepted by the Blue Cross editing system Reports are available for up to 120 days Accepted Claims Reports The next workday following the submission of your Blue Cross claims you will receive an ACCEPTED CLAIMS report This report confirms claims that were accepted and processed by the Blue Cross system Claims whether filed directly through iLinkBLUE or Blue Cross provider downl
17. ing location as well as an overview of the methodology used to develop these cost ranges e The Reconsideration Form is only available to providers during the reconsideration period prior to each cost data submission During times outside this window the link to the form will be inactive Prior to submitting the interactive electronic form you will have the option to print a copy for your records All required fields must be completed in order to submit the form electronically Faxed or mailed forms will not be accepted e The FAQs option is a printable PDF listing of frequently asked questions about the Estimated Treatment Cost tool and data to help our providers better understand the cost data process and the member tool e The Treatment Codes Listing is a printable PDF listing of all the procedures included in the Estimated Treatment Cost tool This listing is updated as we add new procedures and is available to view and print at any time National Consumer Cost Tool MANDATED Version 1 4 Treatment Categories for Fall Refresh 2013 Total ALL 402 Methodology Logic TC Code eee Treatment Categories Code Type Code s ow Submission Format Inpatient Facility Facility Inpatient Facility Facility Inpatient Facility 2 Inpatient Facility 2 Coronary Bypass CABG w o Cardiac Catheterization 6 81 51 81 52 Inpatient Facility 2 C Section Delivery Inpatient Facility 2 Vaginal Delivery Inpatient Facility
18. lts C3 includes the following edits or overrides as they apply to a single code or code pairs Modifier 25 59 and 57 Edit Overrides Age Edits Gender Edits Duplicate Edits Mutually Exclusive Edits Incidental Edits Visit Processing Edits Assistant Surgeon Edits Pre Post Op Processing Edits 30200 12 15 2013 Gender Male Date of Birth 1 1 2000 ee ee Recommend Procedure Date of Service Description Add More Procedures gt gt Review Claim Audit Results Current Claim Allow N 30200 12 15 2013 INJECTION TREATMENT OF NOSE l Mow J 99203 12 15 2013 OFFICE OUTPATIENT VISIT NEW ee Example 2 The patient is a male born January 1 2000 and the provider performed three procedure codes 99203 30200 and 99001 on December 15 2013 Claim Entry After entering the patient s information and codes click the Review Claim Audit Results button When the codes are not compatible you Gender Male Female ur rae es oun ae will receive an edit Click on the Disallow link to see a full description of the claim edit Date of Service 99213 12 15 2013 25 Procedure Mod 1 Mod 2 Mod 3 Mod 4 Claim Audit Results 30200 12 15 2013 99001 42 15 2013 Gender Male Date of Birth 1 1 2000 Recommend Procedure Date of Service Descnption Add More Procedures gt gt Review Claim Audit Results Allow 30200 12 15
19. ng on how many NPIs you have access to Click the EFT Payment Message link to preview an EFT notification or Print amp Download to create a printable PDF Please note that providers not enrolled in iLinkBLUE and EFT do not receive hardcopy payment registers as they are only available through iLinkBLUE REMITTANCE ADVICE The Remittance Advice option allows providers to view remittance advices commonly called payment registers Reports for the current week will appear gt Remittance Advice at the bottom of your remittance listing separate reports for each applicable line Remittance Advice of business Blue Cross HMO OGB and FEP Providers may view remittances for Remittance Advice Total more than one NPI depending on how many NPIs you have access to Much the same as the EFT notifications you may view or print remittances The Remittance Advice Total function is a tool that allows you to query and view the total payment from all of your remittances Blue Cross HMOLA OGB and or FEP as applicable for a given week Like the EFT notifications remittances for a maximum of two years are available in iLinkBLUE Remittance advices may also be saved as electronic copies directly from iLinkBLUE to your computer BlueCard Out of Area iLinkBLUE includes the option to request eligibility and benefit inquiries for both Coverage Information Request out of area Blue Plan and National members It is locat
20. oad feature accepted by the Blue Cross front end editing system will be listed on your ACCEPTED CLAIMS report It is very important that you check your NOT ACCEPTED claims report when a submitted claim DOES NOT appear on this report EFT NOTIFICATIONS Not Accepted Claims Reports Claims entered directly into iLinkBLUE will not be on the NOT ACCEPTED report as they must pass all edits to be accepted into our claims processing system at the point of entry Claims entered through Blue Cross provider download feature that are not accepted by the Blue Cross front end editing system are listed on your NOT ACCEPTED claims report These claims must be corrected and rebilled A NOT ACCEPTED claim will NOT be found on the Blue Cross pended or processed screens found under the Claims Research menu option of iLinkBLUE as they ve never been accepted into our claims processing system Electronic Funds Transfer EFT is a free service where Blue Cross deposits your payment directly into your checking account By clicking on EFT Notifications you can access your latest EFT statements showing your most recent as well as past weekly payment transactions A maximum of two 2 years of EFT notifications is available in iLinkBLUE EFT notifications for the current week will automatically appear at the bottom of the screen All lines of business Blue Cross HMO OGB and FEP will display and you may see EFT notifications for more than one NPI dependi
21. r the specialist performing the procedure and one approval for the facility where services will be performed The authorization does not indicate two colonoscopy procedures have been approved e With the American Specialty Health AIM option or high tech imaging authorizations option providers are redirected to an external site called the ProviderPorta administered for Blue Cross by AIM Ordering physicians must contact AIM for the authorization of the services for Blue Cross HMOLA and Federal Employee Program FEP members AIM conducts authorization services for the following outpatient non emergent imaging services x Computerized Tomography CT Scans x Computerized Tomography Angiography CTA x Magnetic Resonance Imaging MRI x Magnetic Resonance Angiography MRA x Nuclear Cardiology Procedures x Positron Emission Tomography PET Scans The ordering physician whether a primary care physician or a specialist is required to provide AIM with basic clinical information and patient demographics and obtain a notification number The PCP is not expected to obtain the notification number when the specialist orders the test The facility that performs service s cannot obtain a notification number but they can check the status of the notification request in AIM s ProviderPortal In addition to using AIM s ProviderPortal ordering physicians may also contact AIM directly at 1 866 455 8416 For more information on imaging aut
22. s Connection ee The Claims Inquiry Manual provides step by step details on the many functions of Hospital iLinkBLUE outlined in this newsletter Professional Allowable Charges The BlueCard link gives you access to The BlueCard Program Office Manual which is designed to provide information to aid you in servicing members of a Blue Plan other than Blue Cross and Blue Shield of Louisiana The BlueCard Out of Area Tool User Manual provides step by step instructions on using the BlueCard Out of Area function highlighted at the top of this page The ITS Overpayments Notification form is a printable PDF form that providers should complete when they feel an overpayment has been made to a BlueCard member s claim The Clear Claims Connection Manual provides step by step details on the many functions of the Clear Claims Connection tool that is outlined on Page 9 of this newsletter The Dental link gives you access to The Dental Network Office Manual and Dental Network Speed Guide as well as printable PDFs of the FEP Standard Option Dental Allowables Listing and FEP Basic Option Dental Allowable Listing The Hospital link is accessible by facility providers only This is the only location that Blue Cross houses the Member Provider Policies amp Procedures Manual The Professional link gives you access to the HMOLA Provider Manual and Professional Provider Office Manual These manuals are extensions of your Blue Cross and H
23. tract status effective termination dates and other contract related information for FEP members only The When you click on the Claims Entry option on the iLinkBLUE menu a UB04 sub menu with four links is revealed 1500 Contract Prefix Validation e The UBO4 and 1500 screens require a separate security access Applicable providers Place of Service File may use these screens to directly file claims to Blue Cross Please contact Blue Cross EDI department at ilinkblue provider info bcbsla com or 225 293 5465 for more information on filing claims directly through the iLinkBLUE Provider Suite e The Contract Prefix Validation screen verifies where you should directly file a member s claims based on the member ID alpha prefix You must enter the member s alpha prefix claim type inpatient outpatient or professional and beginning date of service e The Place of Service File feature allows you to enter the place of service s once prior to filing claims in iLinkBLUE Then while filing claims in iLinkBLUE your pre entered place of service information can be auto inserted on each claim using a drop down box in the place of service file This saves you from having to re enter the full place of service information on every claim CLAIMS RESEARCH When you click on the Claims Research option on the iLinkBLUE menu a Claims Status sub menu with five links is revealed ITS Out of Area Claims Action Request Inquiry
24. ts Nelwerk Opeatens In 2013 we added a new feature to the message board that gives Indermational la me tate to EDET md get ran st patch rir a Bius Croaa it you an alert message when there are open BlueCard out of area bp Be sate ey anne Z a HNowrbetai The October lieve of HOR News on pubpiches and pramium gace pinadi ii nom maladie medical record requests for your patients You can access current cele ast Rha cameentcats Hews and worked requests by clicking on the link in the alert message or s O You have 15 New Medical Record Requests from the Medical Record Requests option on the iLinkBLUE menu Please visit Medical Record Requests Out Of Area menu to view the requests CONTRACT SEARCH Blue Cross uses unique identifiers called member identification ID numbers in place of using members Social Security numbers This is to prevent identity theft and protect member privacy While Blue Cross Contract SSN 123456789 requires the member ID number for eligibility and benefits verification and claims processing we also understand that at times members may not have their ID card available For this reason there is a contract number search function available in iLinkBLUE where providers may search for a member s ID number using the Social Security number Choose the Contract Search option from the iLinkBLUE menu click on the SSN radio button then enter the member s Social Security n
25. umber and click the submit button iLinkBLUE will return search results of the member ID number associated with that person when there is a match COVERAGE INFORMATION When you click on the Coverage Information option on the iLinkKBLUE menu a gt Coverage Information sub menu with four links is revealed Coverage Summary Eligibility These options are for Blue Cross and Blue Shield of Louisiana and HMO Louisiana Inc members only Contract Benefits Information is not available under these options for BlueCard members FEP Benefits and Eligibility _ e The Coverage Summary screen lists members on the contract active and terminated and allows you to view the member s Coverage Report a detailed health benefit coverage summary that includes deductible and out of pocket amounts that have been met and COB coordination of benefits information when the member also has coverage with another carrier e The Eligibility screen provides information on who is covered on the Blue Cross policy number entered including the effective date and the status of the contract active pended cancelled e The Contract Benefits screen includes a search function to research and view specific member benefits information based on key words such as wellness diagnostic etc This option is for Federal Employee Program FEP members only e The FEP Benefits and Eligibility screen shows copay coinsurance deductible out of pocket accumulation con
26. visions so Chick on a policy to download P check iLinkBLUE frequently for the latest and ahatacept Orencla most current policies Actigraphy e To view medical policies for BlueCard out of area members you must know the member s alpha prefix After entering the member s alpha prefix you will be routed to the member s Blue Plan to access their medical policy information The format for researching medical policies varies from Blue Plan to Blue Plan rea Medical Policy Coverage Guidelines To view the out of area Blue Plan s medical policy information please enter the first three letters of the member s identification number on the Blue Cross Blue Shield ID card and click Submit Alpha Prefix By Category Sample of one Blue Plan s Coverage Guidelines Medical Policy format PRE AUTHORIZATION PRE CERTIFICATION INFORMATION The Pre Authorization Pre Certification Information function on iLinkBLUE allows providers to research and view authorizations for BlueCard out of area members Like researching medical policies for BlueCard members you must enter the member s alpha prefix to be routed to the member s Blue Plan Pre Authorization Pre Certification Information To view Blue Plan s general pre authorization pre certification information please enter the first three letters of the members identification number on the Blue Cross Blue Shield ID card and click Submit
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