Deficit Reduction Act legislation impact to Medicare physician fee schedule
Effective July 1, federal Deficit Reduction Act (DRA) legislation will enact a 10.1% reduction in the Medicare physician fee schedule.
We recognize this reduction may cause considerable hardship for physicians and other health care professionals and potentially impact access for Medicare beneficiaries. Therefore, Regence has decided not to implement the reduction. In addition, we will not implement the reduction for the remainder of 2008, regardless of whether or not the legislation is repealed. This applies only to our Regence MedAdvantage and Preferred Choice Sixty-Five plans; we are obligated to implement the reduction for claims that crossover to Regence when we are a secondary payer to Medicare and for Medicare supplement plans. If subsequent legislation passes approving an increase in the physician fee schedule in 2008, we will implement the increase as required by our contracts.
Please do not submit requests for reprocessing of claims for Medicare Supplement plans or Medicare claims crossed over to Regence for secondary processing. These claims will be paid in accordance with federal requirements as of July 1, 2008.
Coordination of Benefits (COB) electronic billing is now possible
Regence has completed programming changes to accept
electronic submission of Coordination of Benefits (COB)
claims using standard HIPAA American National Standards
Institute (ANSI) formats. As a result, submitting both
institutional and professional COB claims on paper
is no longer required. This applies to all Regence
products except the Federal Employee Program (FEP).
If you are interested in submitting COB claims electronically,
please verify with your practice management software
vendor that your billing program has the capacity to
do so. If so, the information submitted on the secondary
claim should include the amount the other carrier approved,
the amount paid, and the patient balance.
If you have questions about submitting electronic
COB claims, please contact your software vendor. Vendors
or clearinghouses with questions may contact our Electronic
Data Interchange (EDI) Support Center at 1 (800) 713-1693
or via email EDIsupport@regence.com.
National Provider Identifier (NPI) dual-use period extended
Regence is extending the dual-use period until further notice because many entities are still in varied stages of compliance. You may submit your NPI and tax identification (ID) numbers; or submit your NPI, tax ID and Regence provider identifier. We will notify you at a later date when the Regence identifier will no longer be accepted.
New payment vouchers for InnovaSM, EngageSM and BlueCard®members?
By now you should be receiving the new vouchers for our Innova, Engage, and BlueCard business. We hope that you find the improvements in the vouchers helpful. If you are experiencing any issues or difficulties with these new vouchers, or if you have any questions, please contact your Provider Services Representative.
January BlueCard® Claims May be Delayed
We recently announced that beginning December 31, 2007, we are now processing BlueCard claims on our new system. You may experience delays in BlueCard claims submitted in late December through January 16th. During this time, a technical problem caused some transmitted files to be deleted before Regence could process the data. This prevented some of our data transmissions from posting correctly.
In early February, we began processing and mailing payments on a daily basis. At this time, the majority of these files and payments have been received and processed. Beginning March 13, 2008, we will return to our regular weekly payment schedule.
If you have questions or would like more information, contact your provider relations representative or BlueCard Customer Service at 1 (800) 448-0525 or in Portland at (503) 225-5393.
Contacting TriWest? Let Us Help You
Suggestions from TriWest Healthcare Alliance to improve your experience when calling TriWest:
Call 1-888-TRIWEST (888-874-9378) during off-peak hours (after 1:00 pm in your time zone) for a quicker response time.
- Use the Interactive Voice Response (IVR) system to receive information 24-7 without the necessity of speaking to a customer service representative.
- An IVR guide is available in the Provider Connection of www.triwest.com in the Resource Library.
- Specific sections for TRICARE reimbursement rates, referrals and authorizations, claims and reimbursement, TRICARE programs and benefits, the National Provider Identifier (NPI), Electronic Data Interchange (EDI), the Resource Library are also found in the Provider Connection
- Go to Provider Connection to find E-Seminar links allowing seminars at a time most convenient to you.
- Register for the secured Web site to perform functions without calling TriWest. Registered providers have access to a secure portal on www.triwest.com where they can:
- Verify patient eligibility
- Determine status of referrals/authorizations
- Submit claims online, view claims and check claim status
- Download Explanations of Benefits
- See what checks have been issued
ReinventHealthCare.com
Regence is committed to working with members, physicians and employers to create a health care system that works more effectively for everyone. With this goal in mind, we recently launched a web site where anyone interested in health care can share ideas and listen to what others have to say. The site is www.ReinventHealthCare.com.
As a physician, your perspective is essential to an open, honest and productive public conversation. We encourage you to visit the site and join in. Find out more and share your thoughts at ReinventHealthCare.com.
Medicare crossover update
Coordination of Benefits Agreement (COBA) identification number not necessary for secondary crossover claims.
Recently the Centers for Medicare & Medicaid Services (CMS) changed the way in which claim-based crossover information is sent to secondary insurers. (Claim-based crossover occurs when the rendering provider bills Medicare primary, and on that claim, supplies secondary insurance information.) As of 10/1/07, CMS advised providers to obtain a Coordination of Benefits Agreement (COBA) identification number to add to these claims.
Regence already shares its eligibility files with Medicare, and, as a result, receives secondary crossover claims directly from Medicare. It is therefore not necessary for a provider to include a COBA ID on these claims.
If your secondary claims have not been successfully received by Regence, please contact Customer Service at
1 (800) 722-5086
as we may need to add your patient’s Medicare coverage information to our eligibility files.
Important update regarding BlueCard® claims processing
We recently announced that BlueCard® claims would be processed on our new system beginning December 17, 2007. The date has been moved. We will now begin processing BlueCard claims on our new system on
December 31, 2007.
After the conversion referenced above, claims for your BlueCard patients will be reported on our new vouchers. Sample vouchers are available in the Payment section (PDF) of our Provider Office Manual.
As a reminder, clinical editing will also apply to your BlueCard patients’ claims.
Questions
If you have questions or would like more information, contact your provider relations representative or BlueCard Customer Service at 1 (800) 448-0525 or in Portland at (503) 225-5393.
NASCO® claims migrated to new claims system on 1/1/08
The National Account Service Company (NASCO®) claims will be migrated to our new system on January 1, 2008. You will receive a Regence Life and Health voucher for any NASCO claims received prior to December 31, 2007 and any adjustments or recoveries to these claims. You will receive our new voucher (the same voucher used for your InnovaSM, EngageSM and BlueCard® patients) for NASCO claims received on or after January 1, 2008. Sample vouchers are available in the Payment section (PDF) of our Provider Office Manual.
Nelson Trust moved to different health plan effective 1/1/08
The Nelson Trust cancelled its coverage with Regence BCBSO effective December 31, 2007. Members of the Nelson Trust with Regence BCBSO coverage had the alpha prefix NTT. Claims for dates of service through December 31, 2007 will be processed under their coverage with Regence BCBSO.
As of January 1, 2008, members of the Nelson Trust will be covered by Premera BlueCross under new alpha prefixes NLQ (actives) and NQN (<65 retirees). Claims for dates of service beginning January 1, 2008 and after will be processed under their coverage with Premera BlueCross. Please refer to your patients' new member cards for the appropriate alpha prefix.
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