Resource Center
BCBSKC (Blue KC)
- 01/07/2022 - New Edits for Inpatient Billing
- 10/14/2020 - BCBSKC (47171) - Effective January 1, 2021, Blue Cross and Blue Shield of Kansas City (Blue KC) will require the use of your Provider Taxonomy Code on Professional (837P) and Institutional (837I) claims. Claims missing the provider’s taxonomy on the claim will result in a rejection.
Providers – please see the attached letter provided by Blue KC. Questions regarding this letter should be directed to your Blue KC provider representative. - 08/05/2020 - BCBSKC (47171) - Blue Cross and Blue Shield of Kansas City (Blue KC) requires the use of National Drug Codes (NDCs) and NDC units on Professional (837P) and Outpatient Institutional (837I) claims.
Providers – please see the attached letter provided by Blue KC. Questions regarding this letter should be directed to your Blue KC provider representative.
BCBSKS
- Corrected and Voided Claims
- Network Pricing Group Claims
- Professional Claim Ordering or Referring Provider Edits
- Secondary to Medicare Claims
Highmark Western and Northeastern New York
- 02/14/2022 - FEP Dental Highmark Blue Cross Blue Shield of Western New York
- 02/08/2022 - Attention Highmark Western and Northeastern New York Submitters (00301, 00800, 00801 or 55204) Description Required for Non-specific NOC Procedure Codes
- 12/02/2021 - Attention Highmark Western and Northeastern New York submitters (00301, 00800, 00801 or 55204)
- 12/02/2021 - Attention Blue Cross and Blue Shield of Kansas (47163) and Highmark Western and Northeastern New York submitters (00301, 00800, 00801 or 55204)
- 11/05/2021 - Attn: New York Customers - Front End Edit Implementation
- 06/20/2019 - Attn: New York Customers - UPDATE - New National Drug Code (NDC) Requirement Information
- 11/09/2018 - Attn: New York Customers - New Anesthesia Modifier Editing For BCBSWNY, BSNENY, and HNNY
- 08/22/2017 - ATTN: New York Customers – Changes to 835 Health Care Claim Payment/Advice
- Billing Requirements for Ancillary Claim Services
- 10/25/2016 - BlueCross BlueShield of Western New York alliance with Amerigroup
- 02/24/2016 - Attention New York Customers: Important information regarding expanded editing - reposted from 06/21/12
- Highmark Western and Northeastern New York ZIP Code List
- DME Procedure Code List (effective 07/01/2018)
CAQH - Council for Affordable Quality Healthcare
CAQH is a non profit alliance of health plans and trade associations collaborating on initiatives that simplify healthcare administration for health plans and providers. This results in a better care experience for patients and caregivers.
CORE – Committee on Operating Rules for Information Exchange
CORE has more than 140 stakeholders that include health plans, providers, vendors, CMS and others. Together they continuously work on operating rules that build on existing standards.
Payers are mandated by legislation to follow the operating rules. Operating rules support standards and specify the business actions each party must adhere to in order to ensure a high volume of reliable transactions occur smoothly. This reduces the amount of time and resources providers spend on administrative functions.
Software vendors and clearinghouses are not mandated to follow the operating rules but, this creates a good business practice.
Helpful Information for Providers/Vendors testing HIPAA 5010 formats:
- It is suggested a minimum of 25, but no more than 50 claims/requests be submitted for each line of business you wish to test.
- Test files are submitted via SFTP at https://edisftp.bcbsks.com
- The ISA15 should equal "T"
- The trading partner is responsible for downloading and reviewing the acknowledgments, which are available within 1 hour after transmission. Please refer to the Acknowledgments Manual for further information. Contact the EDI Help Desk with any questions regarding testing or acknowledgments, 1-800-472-6481, opt. 1.
Helpful information for Vendors:
- It is important that software vendors review the Companion Guides before sending test files. (Providers will also benefit from reviewing these documents)
- If you wish to test as a vendor, it will work best if you are able to test with an active NPI.
- Implementation guides (TR3’s) are maintained by X12. To obtain a copy of the ANSI ASC X12N implementation guides, please visit their website.