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Individual Blue Cross NC Membership Will Be on New Technology Platform January 1, 2016

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Facilities/Hospitals
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Publication Date

Publication Date: 
2015-12-09

On January 1, 2016, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will go live with our individual (under age 65) membership on our new technology platform, Topaz. This means that you will see new alpha prefixes and ID numbers on these members’ ID cards for 2016.

Some of you are already seeing the new member ID cards and prefixes, as well as new checks generated by this new system. Here are some of the key differences you may notice:

 

New Member Alpha Prefixes 

  • New alpha prefixes for individual members (under 65):
    • Blue Advantage®: YPN (non-Exchange) and YPI (on Exchange)
    • Blue SelectSM:   YPT (non-Exchange) and YPA (on Exchange)
    • Blue ValueSM :   YPJ (non-Exchange) and YPJ (on Exchange)
    • Blue LocalSM With Carolinas Healthcare System: PVY (non-Exchange) and PVX (on Exchange)
    • Blue Local With Duke and WakeMed: DQV (non-Exchange) and DQW (on Exchange)
    • Office of Personnel Management Multi-State Plan:  MZS (on Exchange)
  • Existing small group alpha prefixes:
    • Blue OptionsSM:  YPS (non-Exchange) and YPR (on Exchange)
    • Blue Select:  YPQ (non-Exchange) and YPG (on Exchange)
    • Blue Value:  UPU (non-Exchange) and YPE (on Exchange)

Claims Processing

  • All individual, under 65 Blue Cross NC members will be receiving a new ID card and number. Always make sure you’re using the current ID number for the member. If you file a claim with an expired ID number, it will deny for eligibility due to that policy no longer being active. If a claim is denied for eligibility, please submit a new claim with the correct ID number – do not submit a corrected claim.
  • Claims submitted with multiple providers will be split by Blue Cross NC for processing on behalf of those members who have migrated to the new technology platform.
  • As a result, these split claims may be paid in separate payment cycles, which means you will receive payment more promptly as the approved portion of the claim will be allowed to pay without being held until the other portion is approved.

ID Card Changes

  • ID numbers will no longer have a “W” or “J” after the alpha prefix of the ID number for members on the new technology platform. However, those members who have not yet migrated to the new platform will continue to have these alpha characters in their ID numbers.
  • The “subscriber” suffix will now be 00, the “dependent” suffix will now be 01, and so forth.
  • The ID cards for these members will be made out of hard plastic, which is different from the paper ID cards generated today for members still on our legacy system.

 

New Checks

  • Checks processed for members with any of the above new prefixes will be green (instead of the blue, red or teal checks generated on our current system) and will have a different signatory. This visual change will help your billing office staff (and Blue Cross NC) differentiate these payments from those made on behalf of other Blue Cross NC members.
  • Payments for claims processed on the new technology platform will be issued once a week. The 835 remittance advice will be included with all others you receive the next day.

 

This is the second line of business to be successfully migrated onto the Topaz platform since our initial implementation of small group business in July 2014. Blue Cross NC began migrating to this new technology platform in an effort to better support industry changes, such as Affordable Care Act requirements, as well as to replace our existing claims processing system.

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