Physicians/Specialists
Facilities/Hospitals
Ancillary

Publication Date

Publication Date: 
2016-06-02

We are making progress in processing individual member claims that were delayed due to configuration challenges with our new technology platform.  We have dedicated substantial resources to process claims correctly and make payments to providers.

Claims Processing Updates

  • Claims for Affordable Care Act plans are now processing normally. 
  • We are in the process of fixing configuration issues related to our Grandfathered products, and we have a high level of confidence that these claims (approximately 180,000) will be released in early June.
  • Currently, more than 94 percent of all claims are processing normally. Less than 6 percent of all claims are currently being held.
  • By mid-July, we expect to be current in processing new and first submission claims, as well as claims that normally suspend for additional review, manual intervention, or may require medical records.
  • With the high volume of claims currently moving through our claims processing system, providers may see an increase in claims activity during this time.
  • As you receive and reconcile claims payments, please check to see if you need to refund any advance payments you may have received from your Blue Cross NC patients as you waited for the claims to be processed.
  • Doctors facing financial hardship because of this delay should contact us directly. We have a team in place to guide these requests for individual review and consideration. For more information about this process, please see the details and contact information we recently provided.

 

Checking Claim Status

If you need to check the status of a claim, please use Blue eSM to determine if we’ve received the claim in question.  Any status that shows the claim is in the system is a reliable means of confirming that we have received it.  If the claim has not yet been paid, that is an indicator that the claim is being held.  You may also call the Provider Blue LineSM at 1-800-214-4844 for claims assistance.

Again, please remember this issue affects claims related to services for our individual (under age 65) members, which constitutes a limited percentage of all claims.  Please do not submit duplicate claims, as this will increase our inventory and potentially delay processing time.