| Voucher Information
Two sample vouchers and a document explaining the vouchers
are provided below to help physicians and other health-care
professionals understand their vouchers.
Additionally, we've provided a list of the Facets
explanation codes (PDF) and the ANSI message
code they refer to the vouchers.
Physician
and Other Health-Care Professional Remittance Statement
A link to the ANSI Claim Adjustment codes through the
HIPAA Web site that Regence BlueShield of Idaho utilizes
on the Physician and Other Health-Care Professionals
Remittance Statements. You may notice other ANSI codes
are listed on this Web site. The Claim Adjustment Reason
Codes are to be used for the 835 transaction (Physician
and Other Health-Care Professional Remittance Statements)
and the Claim Status Codes are to be used with the 276/277
(Claim Status) transaction.
Functional Modifiers
A list of the modifiers that will be functional in the
Facets system. Please refer to your CPTTM Manual and
the HCPCS Manual for information about when modifiers
should and should not be used.
Correct Code
Edits
A listing of edits Regence BlueShield of Idaho uses
in addition to the National Correct Coding Initiative
(NCCI).
The CCI Edits Manual are now downloadable from the Centers
for Medicare & Medicaid Services (CMS) Web site.
Accident Report Form
Accident reports are documents that are generated at
Regence BlueShield of Idaho for those patients that
have been injured in accidents that involve a third
party. It is necessary that this form be filled out
completely and legibly, signed by the patient, and returned
to Regence BlueShield of Idaho in order for claims to
be processed correctly. Reports that are created by
physicians or other health-care professionals or do
not contain required information, such as member ID
number, will not be accepted.
EDI
Documents
Electronic Data Interchange (EDI) documents for sending
HIPAA content compliant transactions to Regence Group
Plans through our contract clearinghouse, Availity, LLC.
Current Procedural Terminology (CPT®) codes
and descriptions are the property of the American
Medical Association with all rights reserved.
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 Health Sense 65 and 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.
Note: To print a PDF document, you need Adobe® Reader®. Download it now for free.
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