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Vendor/Clearinghouse Issues 

Blue Cross/Blue Shield THIN Production Issues

The department has been informed that BC/BS THIN experienced two system problems during the period December 13, 2004, through December 31, 2004. One problem was a result of conversions that were implemented by BC/BS THIN beginning December 15, 2004. As a result of this problem, not all claims were transmitted successfully by BC/BS THIN to HFS. The department encourages providers to work directly with BC/BS THIN to ensure that all claims have been transmitted to HFS successfully and reconciled. HFS is actively working with BC/BS in order to assist them in resolving this situation.

There was also a problem where BC/BS THIN was overlaying the provider taxonomy codes, which occurred December 13, 2004, through December 17, 2004. This problem resulted in providers receiving rejections from the department. The rejection error was “U76.” If you received this rejection for claims submitted during the period referenced, providers may want to work directly with BC/BS THIN to ensure that these rejected claims were reprocessed for payment reconsideration.

Update: December ’04:

Blue Cross, Blue Shield THIN (BC/BS THIN) continues to have difficulties with the 837I files that they are submitting to the department. The highest levels of BC/BS (THIN) have been alerted by the department to this problem and the department has made it very clear that we expect BC/BS (THIN) to redouble their efforts to fix these problems immediately and to ensure that these problems do not reoccur in the future. The department continues to work with individual providers to alleviate cash flow problems. Below is a detailed description of the issues being addressed by BC/BS (THIN) and the department.

BC/BS (THIN) will be resubmitting 837I transactions originally submitted to HFS on the dates December 14, 2004, through January 1, 2005, for reprocessing and payment reconsideration. A significant number of claims submitted during this timeframe did not process due to problems with BC/BS file submission. Based on the fact that some of these claims have already been processed through HFS and adjudicated, providers may see an increase in the number of D01 (Duplicate Payment) rejections compared to what they normally receive due to BC/BS (THIN) resubmitting all claims. There may also have been some incorrect payments made to hospitals during this period of time on claims that did process as a result of BC/BS (THIN) overlaying the provider taxonomy code. Hospitals that are enrolled for Category of Service 20 (General Inpatient) and Category of Service 21 (Inpatient Psychiatric) may have been reimbursed at a per diem rate versus a DRG reimbursement. Hospitals that identify an incorrect reimbursement are requested to void the originally submitted claim, with an adjustment, and resubmit a new claim for payment reconsideration.

Update: January 22, 2005:

BC/BS (THIN) has now resubmitted these ‘batches’ of claims to HFS and HFS has taken them into our adjudication system. On January 21, 2005, BC/BS informed HFS that they still have issues with their Direct Data Entry (DDE) system and in particular, with the ‘covered days’ information. BC/BS (THIN) has identified approximately 50,000 claims that were rejected for missing covered days issues (reject codes E84/D09). BC/BS (THIN) is correcting their system and will then attempt to resubmit these to HFS for payment consideration.

Update: January 24, 2005:

BC/BS (THIN) resubmitted the approximately 50,000 claims as noted above to HFS and HFS has taken them into our adjudication system. On January 24, 2005, another issue was identified involving electronic claims from BC/BS (THIN) relating to missing TPL information. This is causing an increased number of claims to be rejected (reject codes R35/R36) in HFS adjudication system.

Update: January 25, 2005:

BC/BS (THIN) has identified approximately 5,000 claims during the timeframe of December 14 – 16, 2004, that rejected for the R35/R36 as noted above. BC/BS (THIN) is correcting their system and will then attempt to resubmit these to HFS for payment consideration. Additionally, BC/BS (THIN) informed HFS that they have identified an issue within their system relating to approximately 350 tertiary claims that they processed on January 21, 2005. These were likely previously rejected by HFS for missing covered days (E84/D09). BC/BS (THIN) is correcting their system and will then attempt to resubmit these to HFS for payment consideration.

Update: January 28, 2005:

BC/BS (THIN) resubmitted the approximately 5,000 claims as noted above to HFS and HFS has taken them into our adjudication system.

Update: February 2, 2005:

HFS has adjudicated ALL claims that BC/BS (THIN) has corrected and resubmitted. In order for you to ensure that BC/BS (THIN) has transmitted all of your claims to HFS, you might consider performing claim status inquiries, on each of your claims during this time period (December 14, 2004 to present). You should contact BC/BS (THIN) regarding any ‘missing’ claims.

HFS continues to assist BC/BS (THIN) in resolving these problems and will continue to update this Web site with the latest information.

Update: July 19, 2005 (Resolved)

The department experienced a problem with some of the claim files that it received from BCBS/THIN beginning June 29, 2005, and ending July 13, 2005. During this time period our translator incorrectly rejected 7 of the 46 files that we received in their entirety. The department has corrected this translator issue and BCBS/THIN retransmitted these files on July 18, 2005.