| Important news:
Revised CMS-1500 (08-05) Claim Form
We will continue to accept the CMS-1500 (12-90)
claim form allowing use of existing stock. Once obtained,
our expectation is that you begin using the revised CMS-1500
(08-05) claim form. Obtain this revised form by contacting
your current supplier. For a negative or PDF version
of the revised form, direct your supplier to:
- The Government Printing Office at (202) 512-0455
- TFP Data Systems at 1500form@tfpdata.com or 1 (800) 482-9367 ext. 1770
No supplier? Visit the Web and use the term CMS-1500 to locate a form supplier today!
The CMS-1500 (08-05) claim form accommodates
the National
Provider Identifier (NPI) reporting. When using
the CMS-1500 form it is important to
note:
- Field 24J is for Type 1 NPIs (Rendering Provider)
- Field 32a is for Type 2 NPIs (Service Facility)
- Field 33a is for Type 1 or 2 NPIs (Billing Provider)
The above fields are split to allow your current Regence provider number in the shaded area and your NPI in the unshaded area labeled NPI.
Use UB-04 claim form
Regence accepts the new UB-04 (CMS-1400) which incorporates fields
for the National
Provider Identifier (NPI).
When using the UB-04 form it is important to note:
- Field 56 is for the NPI of the Billing Facility/Provider
- Field 75 is for Type 1 NPIs (Attending Provider)
- Field 77 is for Type 1 NPIs (Other Referring Provider)
Guidelines for
Timely Submission of Claims
The following guidelines apply to all types of contracted
providers and hospitals across all lines of business
including government programs.
- Original claims must be submitted within 12 months
from the date of service in order
to be processed.
- Any adjustments to the original claim must be submitted
within 12 months from the original
process date.
NOTE: Non Par Providers, per
Medicare guidelines, have 26 months from the date
of service to submit a claim for Preferred
Choice Sixty-Five and Regence MedAdvantage. Any
adjustment to the original claim must be submitted
within 12 months from the original process
date.
Submitting Claims Electronically
Regence BCBSO strongly recommends
submitting claims electronically. Electronic billing
is available for all Regence BCBSO, Trust, Regence Life and Health, and BlueCard out-of-area
products. It offers the following advantages:
- Faster claims turnaround time
- Automated claims payment for clean claims
- Report of claims received
- Single submission point for all traditional, preferred,
and managed care claims
To find out more about submitting claims electronically,
contact the Regence EDI Support Center by phone at
(800) 713-1693, via email at EDIsupport@regence.com,
or complete our online EDI
Support Center Contact Form. You may also visit
our Electronic Transactions
section for more information.
Resubmitting Claims
Claims resubmitted due to nonpayment are also known
as tracer claims, rebills, second submissions, or duplicate
billings. Before submitting tracer claims, use all available
resources to check the status of your claims, including
Regence Online Services for Providers, EDI claims
submission reports, Customer Service and careful voucher
review. Tracer claims:
- Should not be submitted earlier than 20 days from
the original claims submission.
- May be processed separately from "live claims"
("live claims" have priority).
- Are monitored. Providers submitting large volumes
of tracer claims will be contacted to discuss possible
alternatives.
- Submitted on paper should be marked "tracer
claim"
or "rebilling" in the upper
right hand corner or in Block 24 of your CMS-1500
claim form and mailed to:
Regence BCBSO
PO Box 1271
Portland, Oregon 97201-1271
- Submitted electronically, please include "tracer claim"
or "rebilling" in the narrative
record (NSC Record HAO) of the first service detail
line.
Corrected Claims
Claims resubmitted due to changes or corrections
to charges, procedure or diagnostic codes, or other
information may be submitted immediately. Paper claims
resubmitted with changes should be marked "corrected
claim"
in the upper right hand corner or in Block 24 of your
CMS-1500 claim form. If submitted electronically,
please include "corrected
claim"
in the narrative
record (NSC Record HAO) of the first service detail
line.
For UB-04 corrected claims, please use Type of Bill
code 7 Replacement of prior claim as the third digit
and indicate the changes in the remarks field.
Send corrected paper claims to:
Regence BCBSO
PO Box 1271
Portland, Oregon 97201-1271
Please attach the Corrected
Claim - Standard Cover Sheet to your corrected
paper claim to help us identify and route your claim
to the appropriate area for reprocessing.
Predetermination of Dental
Benefits
Predetermination of dental benefits is not a guarantee
of payment. Estimated payment may be reduced due to
prior payments for treatment. Actual benefits payable
will depend upon the following:
- Benefits available
- Benefit maximums in effect when the services are
completed
- Contract limitations
- Patient and provider eligibility
- Provider participating status
Benefits may have been predetermined under the assumption
that the patient is only insured under one policy. If
the patient is insured under more than one policy, actual
benefits payable may be adjusted due to coordination
of benefits or maintenance (non-duplication) of benefits.
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