August 22, 2017

ATTN: New York Customers – Changes to 835 Health Care Claim Payment/Advice

Effective September 5th, 2017 BlueCross BlueShield of Western New York and BlueShield of Northeastern New York will be making a change to their 835 Health Care Claim Payment/Advice. We feel these changes will be beneficial to the providers as the new Adjustment Reason Codes are more descriptive.

When payments are being withheld due to a previous negative balance we will begin using a WO (Overpayment Recovery) Adjustment Reason Code in the PLB segment. When payments are being withheld resulting in a new negative balance we will begin using a FB (Forwarding Balance) Adjustment Reason Code in the PLB segment. Currently a CS (Adjustment) Adjustment Reason Code is used in both of these scenarios. In addition we will provide the previous check number as a Reference Identification Number in the PLB segment to assist with tracking a previous negative balance. Please be aware this previous check number may or may not be the original check where the negative balance began. Provider may need to go back several remittances if necessary.