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CLAIM SUBMISSION:
Blue Medicare PPO claims should be submitted as follows:
- For more accurate claims filing and faster payment, claims should be filed electronically through the Availity Health Information Network.
- Blue Medicare PPO Electronic Payor ID # - TXPPO.
- For information on electronic filing of Blue Medicare PPO claims, contact Availity @ 1-800-282-4548 .
- To contact your Availity Representative or for additional information on electronic claims services, access the Availity Health Information Network Web site at www.availity.com.
- Effective April 10, 2008*
Blue Medicare PPO claims must be submitted within 180 days of the date of service. Claims that are not submitted within 180 days from the date of service are not eligible for reimbursement.Blue Medicare PPO Physicians and other Professional Providers must submit a complete claim for any services provided to a Member. Blue Medicare PPO Physicians and other Professional Providers may not seek payment from the Member for claims submitted after the 180 day filing deadline.
*Note: Prior to April 10, 2008, the claims filing deadline was 95 days.
- Blue Medicare PPO claims may be submitted -
- electronically in the CMS National Standard format (NSF) or the current version of the ANSI 837 format or
- on a completed version of the applicable CMS claim form. Mail claim form to:
Blue Medicare PPO
P.O. Box 3567
Scranton, PA 18503
- Blue Medicare PPO claims (electronic & paper) must be filed with the Member's complete ID number - exactly as shown on the Member's ID card including the 3-digit alpha prefix - ZGD.
Blue Medicare PPO claims containing adequate information and submitted in accordance with these guidelines will be paid within 45 days for paper claims and 30 days for electronic claims.
Duplicate Blue Medicare PPO claims may not be submitted prior to the applicable 30-day (electronic) or 45-day (paper) claims payment period.
If you have questions or concerns about the processing of an individual claim, call Blue Medicare PPO Provider Customer Service at 1-866-706-7745.
SAMPLE REMITTANCE ADVICE:
A sample of the paper provider remittance advice can be viewed by clicking here.
For additional information, please refer to the Blue Medicare PPO Supplement and to the BlueChoice Provider Manual.
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