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Quick Tips for Claims Filing and Information

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At BCBSGa , we strive to process claims quickly and accurately. Did you know that you can make a difference in how quickly claims are processed? You can!  
Following these helpful tips will improve your claim experience:  
Ask members for their current member ID card and regularly obtain new photocopies of it (front and back). Having the current card enables you to submit claims with the appropriate member information (including alpha prefix) and avoid unnecessary claims payment delays.
Check eligibility and benefits electronically at bcbsga.com or by calling 1-800-676-BLUE (2583). Be sure to provide the member’s alpha prefix.
Verify the member’s cost sharing amount before processing payment. Please do not process full payment upfront.
Indicate on the claim any payment you collected from the patient. (On the 837 electronic claim submission form, check field AMT01=F6 patient paid amount; on the CMS1500 locator 29 amount paid; on UB92 locator 54 prior payment; on UB04 locator 53 prior payment.)
Submit all Blue claims to BCBSGa at P.O. Box 9907 Columbus, GA 31908.
Be sure to include the member’s complete identification number when you submit the claim. This includes the three-character alpha prefix. Submit claims with only valid alpha-prefixes; claims with incorrect or missing alpha prefixes and member identification numbers cannot be filed correctly.
In cases where there is more than one payer and a Blue Cross and/or Blue Shield Plan is a primary payer, submit Other Party Liability (OPL) information with the Blue Cross and/or Blue claim. Upon receipt, BCBSGa will electronically route the claim to the member’s Blue Plan. The member’s Plan then processes the claim and approves payment; BCBSGa will reimburse you for services.
Do not send duplicate claims. Sending another claim, or having your billing agency resubmit claims automatically, actually slows down the claims payment process and creates confusion for the member.
Check claim status by calling BCBSGa at the number below or submitting an electronic HIPAA 276 transaction (claim status request) to BCBSGa.
If you have not received payment for a claim, do not resubmit the claim because it will be denied as a duplicate. This also causes member confusion because of multiple Explanations of Benefits (EOBs). BCBSGa’s standard time for claims processing is 14 -21 business days. However, claim processing times
If you do not receive your payment or a response regarding your payment, please call BCBSGa at the number below or visit bcbsga.com to check the status of your claim.  at various Blue Plans vary.
In some cases, a member’s Blue Plan may pend a claim because medical review or additional information is necessary. When resolution of a pended claim requires additional information from you, BCBSGa may either ask you for the information or give the member’s Plan permission to contact you directly.
 
If you have any questions about claims filing for Blue members:  
Talk to your Provider Relations Representative
Visit us online at bcbsga.com
Contact your customer service representative at 1-800-628-3988
 
© 2016 BlueCross BlueShield of Georgia
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.