Filing Electronic Claims to BCBS Arizona payer ID (CentricityEDI)...

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Filing Electronic Claims to BCBS Arizona payer ID (CentricityEDI)...


Article Keywords: BCBS AZ, CentricityEDI, 53589, GEB00011P, GEB00011I

Symptoms: Practice is sending claims through the CentricityEDI clearinghouse. A patient’s insurance card states that electronic claims should be sent to Blue Cross Blue Shield of Arizona (53589). Patient’s insurance is not Blue Cross Blue Shield of Arizona. Claims may be rejected for one of the following reasons:

*** ERROR (8054) *** Payer Name / Payer ID PAYER NAME AND PAYER ID ARE NOT FOR THE SAME PAYER

and/or

*** ERROR (6035) *** ROUTING CLAIM FAILED PRE-MEMBERSHIP ROUTING



Problem Description: When filing claims for another carrier (i.e. Administrative Enterprises, SW Service Administration, Bashas, Zenith Administrators) to the Blue Cross Blue Shield of Arizona payer ID, the name of the insurance carrier must begin with BCBS, and the patient’s policy group number must be specified in patient registration.

Resolution:
1. When setting up the insurance carrier for electronic filing, be sure to complete the following steps (in addition to the usual steps for setting up an electronic insurance carrier):

1. Go to Administration, click Edit and select Insurance Carriers.


2. Search for the insurance carrier in question and double-click to modify it.


3. In the Name field on the Information tab, enter BCBS – followed by the name of the insurance carrier (i.e. Administrative Enterprises should become BCBS – Administrative Enterprises).

NOTE: The List Name can be changed to match the Name, or it can be left unchanged. When you search for an insurance carrier in Administration or Patient Registration, it uses the List Name.

4. Click the EDI tab. Verify that the payer ID entered in each File Creator row is the correct ID for BCBS AZ (GEB00011P for professional claims, GEB00011I for institutional claims). If it is not, double-click the File Creator row, enter the correct payer ID and click OK.



5. Click the Identification tab. Verify that the ID entered in the identification row is the correct ID for BCBS AZ. If it is not, double-click the ID row and enter the correct payer ID in the ID Number field.


NOTE: If there is no row on the Identification tab, click the New button in the lower-left corner to create one, then enter the payer ID in the ID Number field.

6. Click OK.

Failure to complete these steps will result in claims rejecting with the “PAYER NAME AND PAYER ID ARE NOT FOR THE SAME PAYER” message.


2. When adding the insurance information in Patient Registration, be sure to enter the patient’s Policy Group Number in the Policy Group field. Failure to do so will result in claim rejecting with the “ROUTING CLAIM FAILED PRE-MEMBERSHIP ROUTING” error. 

 



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Details
Last Modified:Tuesday, November 02, 2010
Last Modified By: Jaime Hinkle
Type: HOWTO
Level: Beginner
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