Blue Cross and Blue Shield of North Carolina recently communicated with doctors about the claims processing issues many providers have been experiencing. The North Carolina Medical Society (NCMS) staff has fielded numerous calls about the problems over the past few months.  BCBSNC says they are making progress on addressing reported issues.  For example, commercial, State Health Plan, and Federal Employee Program claims processing levels are returning to normal.  Their automatic claims processing rate is back up to 92 percent, which is their historical norm for commercial claims. They expect to have the current claims backlog cleared out within the next 30 to 60 days.

They state that they have addressed the changes that created these claims processing issues, including:

• Claims processing system upgrades and replacement of older systems that resulted in more manual work, decreased automation, as well as impacted productivity and claim-related workflows.
• After the Federal Employee Program claims payment system was migrated to a new platform in October 2013, they experienced delays in claims processing for certain claim types.
• Significant challenges associated with the roll-out of the Affordable Care Act and the federal Marketplace had a domino effect on operational areas. Last-minute changes from the federal government — such as the recent extension of time to complete enrollment — exacerbated these challenges.

BCBSNC has created an escalation process to address concerns about aged claims. If you have outstanding claims greater than 60 days, and you’ve not already spoken to one of their provider specialists, call them at 1-800-214-4844 for assistance.

Here are some of the ways they’re reducing cycle time for processing claims:

• Commercial Claims
  • System enhancements put in place to eliminate many of the claims processing issues.
  • Focused on working through aged claims of 30 days or older.
  • Deployed automation to help clear out duplicate claims in the system.
• State Health Plan Claims
  • Developed a claims inventory reduction plan in January that resulted in a 40 percent reduction in claims inventory over an eight-week period.
  • Claims inventory volumes and processing turnaround times are approaching the levels that were consistently maintained prior to the system upgrades.
• Federal Employee Program Claims Implemented a number of system enhancements and remediation steps to address many of the claims processing issues.  However, a claims payment backlog still remains, and additional post-implementation system enhancements and related efforts to resolve these payment issues are underway.  They are working to process aged claims first.
• For Blue Medicare Claims While Blue Medicare claims have not been significantly affected by system upgrades, BCBSNC is monitoring   metrics to ensure they meet internal standards and CMS-related expectations.  To prevent delays, they have: evaluated certain claim suspends and identified process improvements that are being implemented; reviewed issues that generate a high volume of incomplete claims and outlined opportunities for provider education and collaboration.

How to Help Ensure Your Claims Are Processed As Quickly as Possible

Here are several suggestions from BCBSNC:

• Please do not submit duplicate claims, as they increase inventory and impact timeliness in processing your claims.
• Make sure claims are complete and accurately coded before submitting them for processing.
• Include NPI numbers, Medicare number as appropriate, and your tax ID on the claim.
• Keep your contact information, including address and phone number, up-to-date with BCBSNC.
• Submit any requested or required information in a timely manner.
• Do not send medical records with claims unless specifically requested.
• Check claims status on Blue e^SM (Health Trio link for Blue Medicare claims) prior to calling customer service or resubmitting the claim.  When checking claims status on Blue e, please note the “Pended Status,” as that will indicate if the claim is fully processed or not at this time.

If you experience problems with claims filed with BCBS that cannot be resolved as described above, please call the NCMS at 919-833-3836 and ask to speak to our Solution Center Coordinator, Belinda McKoy, [email protected]. We will continue to monitor the claims processing situation.