Blue Cross and Blue Shield of North Carolina (Blue Cross NC) began migrating to a new technology platform called Topaz last summer in an effort to better support industry changes, such as Affordable Care Act requirements, as well as to replace our existing claims processing system.
In mid-October, Clear Claim Connection (C3) will be enhanced to provide you with more detailed information when you use the C3 application for claim inquiries via Blue eSM. You will be able to get claim detail for claims processed on our new Facets system in addition to the claim detail you can view online today for claims processed on PowerMHS, which is our current claims platform.
Highlights of the Upcoming C3 Upgrade
Here are some of the highlights of the C3 upgrade that will help make your online claims inquiry process quicker and easier:
- You will no longer need to choose a version of C3 based on the date of service. With the new enhancements to C3, version selection will no longer be needed as the date of service required at the line level will automatically access the claims editing effective for that date.
- The majority of our corporate medical policies will now be accessible through the enhanced C3 application, which will result in more transparency, detailed claim information, and an explanation of the medical policy as it relates to the claim in question.
- If key information is omitted, the enhanced C3 application will alert you and prompt you to complete the required fields. The more information you can provide in the Claims Entry window; the more accurate the claims editing result.
- More detail available via the addition of new data fields for “Place of Service” and “Units.”
- Online job aids will continue to be available via the “Help” function when you need more details about how to complete the intake information, etc.
Claims Will Continue to Process on Two Different Platforms
Until all of our commercial business is transitioned to the new Facets claims processing platform by the end of 2016, we will be processing claims on two different systems—Facets and our current system, PowerMHS.
As a result, you may experience differences in claims administration based on which system was used to process the claim. The new system is able to apply additional claim edits more effectively during the front-end processing of the claim.
The new Topaz technology platform provides us with a technology suite for many of our customer interactions, including the sales, enrollment, customer service, claims processing, product administration, and provider experiences. There will be no changes to the fee schedule under your provider contract with Blue Cross NC as a result of the system change.
The transition to the new technology platform will be gradual. Utilizing a controlled, multi-year, phased-migration approach, we expect to have all of our commercial membership migrated onto the new technology platform by the end of 2016. We will continue to keep you updated about our progress via the Important News page on the provider portal on www.bluecrossnc.com.