October 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. 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 at least one of the following items from the other carrier or program when submitting a Coordination of Benefits (COB) claim:
- Third-party Remittance Advice (RA)
- Third-party letter explaining the denial of coverage or reimbursement
COB claims received without at least one of 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.
BCBSTX must receive COB claims within 95 days from the date on the other carrier’s or program’s RA or letter of denial of coverage. When submitting COB claims, specify the other coverage in:
- Boxes 9a-d of the CMS-1500 claim form
- Boxes 58-62 of the CMS-1450 (UB-04) claim form
If the member has BCBSTX Medicaid as secondary and you need to file electronically please ensure the following is included:
- The other carrier’s information
- Primary payer payment/adjustment information
If you have questions about how to file secondary claims with BCBSTX, reach out to BCBSTX’s E-business consultants at PECS@bcbsil.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, then Medicaid is always the payer of last resort. Additional funds will pay up to the Texas Medicaid fee schedule.
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.