Blue Review
A newsletter for Medicaid providers

November 2018

How to Keep the Cash Flowing: Billing BCBSTX Medicaid as a Secondary Insurance

To keep the cash flowing, it’s important to understand secondary billing. When applicable, Blue Cross and Blue Shield of Texas (BCBSTX) coordinates benefits with other carriers and programs that a member may have for coverage, including Medicare. Secondary claims may be submitted to BCBSTX by paper (using the CMS-1500 and UB-04 claim forms), or electronically via Availity® or your preferred web vendor. BCBSTX must receive Coordination of Benefits (COB) claims within 95 days from the date on the other carrier’s or program’s Remittance Advice (RA) or letter of denial of coverage.

Submitting Secondary Claims to BCBSTX via Paper Claim Forms
You will need to indicate “other coverage” information on the appropriate claim form if BCBSTX is the secondary payer. If there is a need to coordinate benefits, include the following items from the other carrier or program when submitting a COB claim:

  • Third-party RA
  • Third-party letter explaining the denial of coverage or reimbursement

COB claims received without these items will be returned to you with a request to submit to the other carrier or program first. Please make sure that the information you submit explains any coding listed on the other carrier’s RA or letter. We cannot process the claim without this specific information.

When submitting COB claims, specify the other coverage in:

  • Boxes 9a-d on the CMS-1500 claim form
  • Boxes 58-62 on the CMS-1450 (UB-04) claim form

Submitting Secondary Claims Electronically
When submitting electronic BCBSTX Medicaid claims as secondary, ensure the following is included:

  • Loop 2330B – Other Payer Name
    • Segment NM1
  • Loop 2330B – Other Payer Secondary Identifier
    • Segment REF
  • Loop 2320 – Other Subscriber Information
    • Segment SBR
  • Loop 2320 – Claim Level Adjustments (if the primary claim was paid by the primary payer and claim level adjustments were made at the claim level)
    • Segment CAS
  • Loop 2320 – Payer Paid Amount
    • Segment AMT
  • Loop 2330A – Other Subscriber Name
    • Segments NM1
  • Loop 2330B – Other Payer Name
    • Segment NM1
  • Loop 2430 – Line Adjudication Information (if the primary claim was paid by the primary payer and service level adjustments were made at the service line level)
    • Segments SVD, CAS, DTP

If you have questions about how to file electronic secondary claims with BCBSTX, you may contact BCBSTX’s Provider eBusiness Consultants at PECS@bcbstx.com. If you need assistance from Availity (BCBSTX’s claims clearinghouse), please call 1-800-282-4548 or visit availity.com. If you use a different vendor, please contact them with your questions about filing BCBSTX as secondary.

Please remember that if a commercial payer exists, Medicaid is always the payer of last resort. Additional funds will pay according to the Texas Medicaid fee schedule, which means if the primary insurance payer pays more than Medicaid’s allowable for the service, then provider reimbursement is $0. If Medicaid’s allowable is greater than the primary insurance payment, then the difference will be paid.

Claim Filing with the Wrong Plan
If you file a claim with the wrong insurance carrier and then provide documentation verifying the initial claim filing was within 95 days of the date of the other carrier’s denial letter or RA form, BCBSTX will process your claim without denying it for failure to file within filing time limits.

Claim and billing guidelines can be found in Chapters 5-7 of the STAR Kids provider manual and Chapters 6-8 in the STAR/CHIP manual.

If you have any questions regarding this process, please contact the BCBSTX Medicaid Network Department at 1-855-212-1615 or via email at TexasMedicaidNetworkDepartment@bcbstx.com.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third-party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.