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 Regence MedAdvantage. Any adjustment to the original claim must be submitted within 12 months from the original process date.

There might be times where an exception to above guidelines may apply (i.e. Coordination of Benefits related claim, Adjustments, etc.). A timely filing exception is not considered a Provider Appeal. You typically will be required to submit documentation for proof of a timely filing exception. If you have questions about a timely filing denial, please contact the appropriate customer service department.

Submitting Claims Electronically

Regence 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

Find out more about submitting claims electronically.

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 the Provider Center, 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.

Corrected electronic claims
Claim corrections can be sent to us in an electronic format. Please indicate in the 2300 loop the CLM 05-3 if the claim is an original=1, replacement =7 or corrected =6. Please include "corrected claim" in the narrative record (NSC Record HAO) of the first service detail line.

Corrected paper claims
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.

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:
P.O. Box 30805
Salt Lake City, UT 84130-0805

Please attach the Corrected Claim Cover Sheet (PDF) 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.