Blue Medicare Providers: Reminder to Include All Required Information on Claims

***PLEASE DISREGARD THIS ARTICLE.  PLEASE REFER TO THE UPDATED ARTICLE POSTED ON DECEMBER 7, 2015.***

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to remind our Blue Medicare^SM network providers that you are required to include your Medicare provider number, national provider identifier (NPI) and tax identification number (TIN) on all claim submissions. If the information does not match what is on file with Blue Cross NC, or if a provider or provider group is not set up in our system to render services as a Blue Medicare network provider/provider group, Blue Cross NC will no longer mail these claims back. Claims will deny and will also not be viewable in Blue e^SM for status until the required information is received.

Important claim tips:

• Once NPI information is registered with us and we have confirmed receipt, claims must be reported using the appropriate provider/group NPI(s) that match the NPI(s) that is/are registered for your health care business.
• The TIN must correspond to the NPI or provider number filed.
• Claims will be rejected and mailed back to the provider if the NPI or TIN number that is registered with us is not listed on the claim form.
• For the date of service filed, our records must indicate that the individual provider has been reported and set-up as part of the group’s practice.
• To receive payments, providers/groups must have a provider/group number, must be credentialed and have a Blue Medicare contract with Blue Cross NC. Information about how to enroll as an in-network provider with us is available online at bluecrossnc.com.

As a Blue Cross NC-participating Blue Medicare provider, you are responsible for accurate submission of claims. If you find that your information needs to be updated, please complete and return a Demographic Information Form that can be found on the “Forms and Documentation” page on our Web site at bluecrossnc.com/providers, or contact Blue Cross NC Network Management at 1.800.777.1643. Our staff is available to assist you Monday through Friday, 8 a.m. - 5 p.m. EST. Blue Cross NC Network Management staff can also assist you with any questions you may have regarding the provider enrollment process.