Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association.
Going
Green
with BCBSNE
Health Network Services
March 25, 2014
Agenda
• Why electronic submission?
• Medical records and attachments
• Electronic remittance and funds transfer
• Market options for electronic submission
• PC-ACE
837I/P Electronic Submissions
93.50%
94.00%
94.50%
95.00%
95.50%
96.00%
96.50%
Feb
2013
March
2013
April
2013
May
2013
June
2013
July
2013
Aug
2013
Sept
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
% 837I Electronic
89.00%
90.00%
91.00%
92.00%
93.00%
94.00%
95.00%
Feb
2013
March
2013
April
2013
May
2013
June
2013
July
2013
Aug
2013
Sept
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
% 837P Electronic
90.00%
91.00%
92.00%
93.00%
94.00%
95.00%
Feb
2013
March
2013
April
2013
May
2013
June
2013
July
2013
Aug
2013
Sept
2013
Oct
2013
Nov
2013
Dec
2013
Jan
2014
Feb
2014
% I/P Electronic
Institutional Transactions
Professional Transactions
837P Submissions
Month
837P Electronic
837P Med-X
837P Paper
837P Total
Feb 2013
385,470
37,865
39,819
463,154
March 2013
406,870
42,554
40,207
489,631
April 2013
376,550
39,142
36,143
451,835
May 2013
461,828
43,628
35,538
540,994
June 2013
404,469
39,332
36,503
480,304
July 2013
365,470
33,117
32,114
430,701
Aug 2013
479,383
40,643
39,448
559,474
Sept 2013
418,197
33,999
31,676
483,872
Oct 2013
549,974
38,824
42,265
631,063
Nov 2013
472,331
40,371
30,270
542,972
Dec 2013
516,806
34,677
36,151
587,634
Jan 2014
508,679
42,469
37,092
588,240
Feb 2014
444,574
40,422
30,638
515,634
YTD-2014
953,253
82,891
67,730
1,103,874
What do these numbers mean?
• 10,103,935 total claims in 2013
• 76% of electronic claims auto-processed
• Paper claims require manual entry and handling
• Paper claims currently 7.5%, was 10% in
February 2013
Benefits of Electronic Submission
• No postage or paper forms costs
• Confirmation of receipt
• Claims data is edited for accuracy and rejections
are returned to submitter within 24 hours
• Corrected or replacement claims are easy to
resubmit
• Faster payment time
When Paper is Needed
• Cost invoices
• Unusual procedural services (Modifier 22)
• Do not send medical records unless requested!
Going Green
• Electronic Funds Transfer
Trading Partner Registration and Agreement
PC-ACE Software – What is it?
• In order to transmit electronic claims to
BCBSNE, you must have electronic medical
billing software.
• If a practice doesn’t have software, PC-ACE is a
“free to provider” medical billing software.
BCBSNE pays for the license for the software for
our providers to use.
• Professional and Institutional providers are
users.
PC-ACE Installation
When EDI Support receives Trading Partner
information, we will confirm with the provider if they
need our software.
• Installation requirements
– The software is not Mac compatible
– Cannot be installed on the same machine that has
Medicare’s PC-ACE program
• Internet Explorer is the preferred browser
• It will be necessary to turn off any anti-virus software on your
computer to do the installation.
• Allow 20 minutes to install the program into your computer.
PC-ACE Installation
• Initial download of program will prompt a
Security Warning – Select Run.
PC-ACE Installation – Key Points
• Once install starts, a password will be
requested, which will be provided when setup is
initiated.
• License Agreement needs to be accepted and
then select Continue.
• The software program will be installed on the
computer’s “C” Drive.
PC-ACE Installation
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Once installed, the
program is located
in your computer on
the C drive.
PC-ACE Installation
• Start Installation – Click Next
PC-ACE Installation
• Success!
The program is installed. A message may ask about
proper installation, just click
“This program installed
correctly”
Setting up PC-ACE for Use
• Once the program is installed, it needs to be customized
with applicable provider data. PC-ACE allows for two
types of provider creation.
– Providers (Institutional ) – providers submitting UB’s
or
– Provider (Professional ) – providers who bill with a HICFA
1500)
Setting up PC-ACE –
Institutional Provider Example
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Setting up PC-ACE – Group Practice Example
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Setting up PC-ACE – Trading Partner/Submitter
• The Trading Partner Agreement has established the
provider as a Trading Partner/Clearinghouse with
BCBSNE.
• Basically, the individual provider is now the Submitter of
electronic claims to BCBSNE.
• This setup will utilize the unique Trading Partner number
EDI Support will provide to you.
Setting up PC-ACE – Submitter DATA
• Providers will create the background detail that allows
the electronic HICFA 1500 or UB to pass into BCBSNE.
Setting up PC-ACE: Patient Data Files
The creation of Patient Files will speed up entry of claims.
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PC-ACE Claim Creation
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Many boxes can be auto filled, right clicking can bring up options
for LOB, Billing Provider, Patient Control Number, etc.
PC-ACE Claim Creation
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After creating a claim, it must be saved. An information box will appear, providing
an opportunity to see any simple errors such as missing POS, signature on file,
etc.
PC-ACE Claim Creation – Auto Fill Info
• Providers can right click on many of the option
boxes while keying in claims.
– Line of Business, Patient Selection, Provider
Selection, ICD9, ICD10, Place of Service codes,
Procedure codes, and many more.
PC-ACE Claim Submission
• The software creates a claim file
• The file is stored on the “C” drive of the computer –
the file is called BSTRANS.dat. Providers upload
data the to secured URL/website.
PC-ACE Claim Submission
• Once set up, the provider is given a secured
website where claims can be uploaded.
Claim Acknowledgement – All claims correct!
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This report shows all claims sent were accepted. If a file has errors, all
good claims are accepted and the claims with edits do not enter the
system.
Claim Acknowledgement – CCR Advising Bad Data
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