February 2004 Newsletter

To 'Q' You In

By: Janet Browning, Quality Assurance

Medicare Part B - Carrier Jurisdiction Changes

Effective for claims received on or after April 1, 2004, providers are required to complete Block 32 of the CMS-1500 claim form and appropriate electronic fields whenever a service is performed in a setting other than the patient's home. Services performed in an office setting will also require this information. Payment of services under the Medicare Physician Fee Schedule will be made based on the ZIP code where the service is provided. The name of the facility (or practice) and complete mailing address, including ZIP code, must be included in Block 32 of the CMS-1500 claim form.

Note: this requirement is based on claims submitted April 1, 2004 and after. Any electronic claims submitted to Quadax March 31, 2004 and after will reject if this data is missing.

Blue Cross Blue Shield - Member Identification Number Conversion

Many states have passed identity theft laws designed to protect the confidentiality of Social Security Numbers for state residents. The laws restrict the use of Social Security Numbers as customer identifiers by non-governmental entities and individuals. The Blue Cross Blue Shield Association is adopting this approach nationwide.

Most Blue Cross Blue Shield affiliates have already begun a transition to the new unique member identifier (UMI). This transition is expected to continue until 2006, and old numbers will continue to be accepted. Specific deadlines for using only the new numbers have not been determined as of yet.

The Blue Cross Blue Shield UMI can be up to 17 characters (three alphabetical prefix characters, followed by up to 14 alpha-numerical characters). Other than the first three characters, local affiliates can determine the length and format of the identifier.

Other commercial insurance companies, such as Aetna and Qualchoice, are also following this trend of converting from Social Security Numbers to identify plan members.