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BlueCare
Plus
HMO
D
‐
SNP
℠
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This Guide was current at the time it was published or uploaded onto the web. This Guide is a general summary that ex-plains certain aspects of the BlueCare Plus℠ Program; however, this is not a legal document and does not grant rights or impose obligations. BlueCare Plus will not bear any responsibility or liability for the results or consequences of using this summary guide. Providers are responsible for the correct submission of claims and response to any remittance advice in accordance with current laws, regulations and standards.
This document is designed as a self-help resource for BlueCare Plus providers. Use of this guide offers the user the follow-ing benefits:
Easy access to general information about the RA;
Increased ability to understand and interpret the reasons for denials and adjustments; Reduction in the resubmission of claims;
Rapid follow-up action, resulting in quicker payment; and
BlueCare
Plus
DETAILED PAYMENT INFORMATION REQUIRED ELECTRONIC SUBMISSION MORE EFFICIENT PROCESSING GUARANTEED RECORD OF RECEIPT EFFICIENT CLAIMS TRACKING SUBMIT SECONDARY CLAIMS MAY ACCESS THROUGH BLUEACCESS FOR MORE INFORMATION CONTACT eBUSINESS Enrollment 1‐800‐924‐7141 Support 1‐423‐535‐5717
ELECTRONIC
REMITTANCE
ADVICE
(ERA)
What
is
the
BlueCare
Plus
Remittance
Advice
The Remittance Advice (RA) is a document supplied by BlueCare Plus that
provides notice of an explanation for payment, adjustment, denial and/or
uncovered charges of a submitted medical claim.
There are two types of Remittance Advice
Electronic Remittance Advice (ERA)
Standard Remittance Advice (SRA)
The ERA allows the ability to post payment information automatically and
assists in identifying denials made during the billing to make necessary cor‐
rections. An electronic remittance advice (ERA) is the electronic version
of BlueCare Plus payment explanation, which provides details about pro‐
viders' claims payment. If the claims are denied, the remittance advice
would contain the required explanations. The industry standard for send‐
ing ERA data is the HIPAA X12N 835 standard. BCBST provides Electronic
Remittance Advices (ERAs) in the ANSI Version 5010 format.
The RA provides justification for the payment, as well as input to your ac‐
counting system/accounts receivable and general ledger applications. The
codes on the RA identify any additional action you may need to take; for
example, an RA code (RAC) may indicate you may need to resubmit the
claim with corrected information
The RA provides detailed payment information about a health care
claim (s) and describes the payment; it also features valid codes and spe‐
cific values that make up the claim payment. Once you receive the RA you
may,
Post the decision and payment information automatically when a
compatible provider accounts receivable software application is be‐
ing used; and/or
Identify reasons for any adjustments, denials or payment reductions
BlueCare
Plus
ANSI Version 5010
eBusiness Tools & Resources
Technical Information
Blue Core System
Blue Access for Providers
Electronic Claims and Electronic Funds
Transfer
Getting Started with eBusiness
FOR MORE INFORMATION CONTACT eBUSINESS SOLUTIONS Enrollment 1‐800‐924‐7141 Support 1‐423‐535‐5717 (Option 2)
ELECTRONIC
REMITTANCE
ADVICE
(RA)
Helpful
Links
ERA advices are not easily readable while in ANSI Version 5010 format. Con‐
tact your software vendor if you would like to know if your software can trans‐
late or automatically post account information from the ERA. ERA files can be
downloaded using the BCBST’s Secure File Gateway (SFG).
Providers should contact their vendor prior to requesting ERAs to ensure their
vendor can support translation of the ERA. Detailed ANSI Version 5010 specifi‐
cations for the ERA are available at www.wpc‐edi.com
In addition, providers may view remittance advice information on
BlueAccess℠, the secure area of bcbst.com. The Remittance Advice informa‐
tion will be online PDF versions of provider‘s paper remits.
BlueCare
Plus
The Remittance Advice is divided
into three major columns
Patient Information Claim Information Payment Information
STANDARD
REMITTANCE
ADVICE—PROFESSIONAL
CLAIM
Field Description
Line of Business MV01 represents BlueCare Plus line of business
Remit/Check Date This field displays date the RA is issued
Internal Provider
Number
This field displays the medical record number (MRN)
or patient account number that was submitted on
the claim form
NPI Number This field displays the assigned National Provider
Identifier (NPI) number
Tax Identification
Number
Identification number used by the Internal Revenue
Service (IRS) in the administration of tax laws
Check Number Indicates the check number assigned to the RA
Remittance Number Sequential number assigned to the RA
Page Number Number of pages contained in the remittance advice
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BlueCare
Plus
Field Description
Last Name This field displays the last name of the BlueCare
Plus member
First Name This field displays the first name of the BlueCare
Plus member
Patient Account This field displays the medical record number
(MRN) or patient account number that was submit‐
ted on the claim form
Member ID This field displays the assigned member identifica‐
tion number for the BlueCare Plus member
Field Description
Claim Number This field displays the claim number assigned to
the claim at the time it is received by BlueCare
Plus
Recvd DT This field indicates the received date for claim
processing
Date of Service
From/Thru
Indicates the start date of service and the last
date of service on the processed claim
Procedure/Modifier Indicates the HCPC , CPT and modifier used
Total Charges This field indicates the total charges submitted
by the provider
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BLUECARE
PLUS
DUAL
ELIGIBLE
BlueCare Plus will forward claims
for TennCare eligible members to the
Bureau of TennCare for the processing
of member cost sharing. The patient
deductible, co‐pay and/or coinsurance
amounts should not be billed to the
member except when the member has
lost their TennCare eligibility
BlueCare
Plus
Field Description Patient Non‐ Covered
This field indicates the number of non‐covered days
or visits that are submitted by the provider when it is
known that the days or visits are not covered by
Medicare. Providers do not anticipate payment on
non‐covered days or visits.
Note Remittance Advice remark codes
Contract Write
Off
This field indicates an adjustment resulting from a
contractual agreement between the provider of ser‐
vices and BlueCare Plus.
Note Remittance Advice remark codes
Patient DED/ COPAY
This field indicates the deductible and co‐pay for cov‐
ered services the deductible/co‐pay should not be
billed to the member. This amount will be automati‐
cally crossover to TennCare℠ for processing of mem‐
ber cost sharing
Patient COINS This field shows the total dollar amount of coinsur‐
ance for which the beneficiary is responsible.
Other Insurance This field indicates if other insurance or coverage ap‐
plicable
Claim Paid This field indicates the amount paid by BlueCare Plus
Interest Paid This field indicates if any interest has been applied to
the amount paid
Patient Owes This field will indicate the amount due from the mem‐
ber. BlueCare Plus members have $0 cost sharing . A
file is submitted to the Bureau of TennCare for the co‐
BlueCare
Plus
The Remittance Advice is divided
into three major columns
Patient Information
Claim Information
Payment Information
STANDARD
REMITTANCE
ADVICE—
FACILITY
CLAIM
Field Description
Line of Business MV01 represents BlueCare Plus line of business
Remit/Check Date This field displays date the RA is issued
Internal Provider
Number
This field displays the medical record number (MRN)
or patient account number that was submitted on
the claim form
NPI Number This field displays the assigned National Provider
Identifier (NPI) number
Tax Identification
Number
Identification number used by the Internal Revenue
Service (IRS) in the administration of tax laws
Check Number Indicates the check number assigned to the RA
Remittance Number Sequential number assigned to the RA
Page Number Number of pages contained in the remittance advice
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BlueCare
Plus
Field Description
Last Name This field displays the last name of the BlueCare
Plus member
First Name This field displays the first name of the BlueCare
Plus member
Hosp Chart This field displays the medical record number
(MRN) or patient account number that was submit‐
ted on the claim form
Member ID This field displays the assigned member identifica‐
tion number for the BlueCare Plus member
Field Description
Claim Number This field displays the claim number assigned to
the claim at the time it is received by BlueCare
Plus
Received Date This field indicates the received date for claim
processing
Date of Service
From/Thru
Indicates the start date of service and the last
date of service on the processed claim
Rev CD Indicates the revenue code to identify specific
accommodation and/or ancillary charges
Total Charges This field indicates the total charges submitted
by the provider
Proc Code Uniform coding that accurately describes medi‐
cal, surgical and diagnostic services
DRG Diagnosis Related Group (DRG) used to assign
inpatient hospital services
Unit Quantifying of services by revenue code cate‐
gory, e.g., number of days in a particular type of
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BLUECARE
PLUS
DUAL
ELIGIBLE
BlueCare Plus will forward claims for
TennCare eligible members to the
Bureau of TennCare for the processing
of member cost sharing. The patient
deductible, co‐pay and/or coinsurance
amounts should not be billed to the
member except when the member has
lost their TennCare eligibility
BlueCare
Plus
Field Description Patient Non‐ Covered
This field indicates the number of non‐covered days
or visits that are submitted by the provider when it is
known that the days or visits are not covered by
Medicare. Providers do not anticipate payment on
non‐covered days or visits.
Note Remittance Advice remark codes
Contract Write
Off
This field indicates an adjustment resulting from a
contractual agreement between the provider of ser‐
vices and BlueCare Plus.
Note Remittance Advice remark codes
Patient DED/ COPAY
This field indicates the deductible and co‐pay for cov‐
ered services the deductible/co‐pay should not be
billed to the member. This amount will be automati‐
cally crossover to TennCare for processing of member
cost sharing
Patient COINS This field shows the total dollar amount of coinsur‐
ance for which the beneficiary is responsible.
Other Insurance This field indicates if other insurance or coverage ap‐
plicable
Claim Paid This field indicates the amount paid by BlueCare Plus
Interest Paid This field indicates if any interest has been applied to
the amount paid
Patient Owes This field will indicate the amount due from the mem‐
ber BlueCare Plus members have $0 cost sharing . A
file is submitted to the Bureau of TennCare for the co‐
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RA
REMARK
CODES
Remark codes are used to provide
additional explanation for an adjust‐
ment or convey information about the re‐ mittance proc‐ essing Remittance Advice code descriptions are available at bluecareplus.bcbst.com/provider‐ resources/
BLUEACCESS
℠
To view/print your remittance advices,
ensure you have access to BlueAccess,
BCBST’s secure area
bluecareplus.bcbst.com. To register, just
click on the “Register Now” link located in
the BlueAccess section on the website
and follow the simple instructions to ob‐
tain a user ID and password
12
Customer service is more than just a name on a depart‐
ment door. Customer service is more than answering ques‐
tions quickly and correctly. Customer service is the very
heart of BlueCare Plus, talking personally, individually, to our
members and providers. We work as a liaison between
members and providers, helping customers access their
benefits.
BlueCare
Plus
Customer
Service
BLUECARE
PLUS
1 Cameron Hill Circle
Chattanooga, TN 37402
800‐299‐1407 ph
888‐725‐6849 fax
Bluecareplus.bcbst.com.
simplifying
BlueCare Plus Tennessee, an Independent Licensee of the
BlueCross BlueShield Association. BlueCare Plus is an HMO
SNP plan with a Medicare contract and a contract with the
Tennessee Medicaid Program. BlueCare Plus focuses on
managing care and providing quality health care products,
services, and information for government programs. We
take great pride in serving the people of Tennessee, both in
our products and services and in our numerous outreach
