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The Systems staff at BCBSAZ Medicare Part A is available weekdays from 8:00 am to 4:30 pm to assist trading partners and providers with the electronic exchange of data to maximize the efficiencies of ANSI transaction sets. By implementing standard electronic transactions, trading partners and providers will benefit with cleaner claims, faster payment, administrative cost savings and increased efficiency. Please refer to the DDE, PC Ace and PC Print options on this website for submitting electronic HIPAA compliant claims and receiving electronic remittance advices to and from BCBSAZ Medicare Part A.
Staffing
The BCBSAZ Medicare Part A Systems Liaison staff can assist you with your needs or can refer you to a Liaison who may be more knowledgeable on a specific topic. After contacting the Provider Services staff first and find that you still have the need to contact our Systems staff, we ask that you please contact the Systems staff in the order listed.
Kellie Mann
Systems Liaison II
(602) 864-4019
kmann@phx1.bcbsaz.com
Stacy McLaren
Business Analyst Supervisor
602-864-4393
smclaren@phx1.bcbsaz.com
4010 Specifications
Documentation on all HIPAA transactions and their addenda’s may be found at:
http://www.wpc-edi.com/hipaa
CMS EDI Information
http://www.cms.hhs.gov/TransactionCodeSetsStands
Most Common EDI Errors Seen at BCBSAZ Medicare Part A:
The following lists for you the most common EDI errors along with guidelines to eliminate these errors.
A. Subscriber Detail
1. 2000B SBR 02 99 PAT REL 2 INS CANNOT BE SPACES
***Use this code only when the subscriber is the same person as the patient. If the subscriber is not the same person as the patient, do not use this element. Code to use: 18, definition: Self.
2. 2000B SBR 09 99 PAYMENT SRCE CD NOT = MA
***Code identifying type of claim. If submitting a Medicare primary claim (Medicare is in SBR04), Code to use: MA
B. Patient Hierarchical Level Detail
1. 2000C PAT 01 99 DEPENDENT TO SUBSCRIBER IS NOT ALLOWED
***Dependent to Subscriber record 400 is not currently allowed under Medicare and will be rejected.
C. Claim Information
***The following errors are received when a non-valid or incorrect code is listed within the segment. For Example, Diagnosis codes may have changed from a four digit Medicare requirement to a five digit code to be considered a valid diagnosis code for Medicare.
2300 HI 01 99 VALUE CODE INVALID
2300 HI 02 99 ADMIT DIAG CODE INVALID
2300 HI 02 99 OTH DIAG CODE INVALID
2300 HI 02 99 PRIN DIAG CODE INVALID
2300 HI 02 99 CONDITION CODE INVALID
2310A REF 02 99 ATTN PHYS UPIN REQUIRED
2330B N4 02 99 OTHPYR STATE INVALID
2400 DTP 03 99 SERVICE DATE REQUIRED FOR OUTPAT
CMS EDI Support Information
CR3875 EDI Support Requirements - Please review this latest CMS Change Request that revises which includes changes and clarifications that apply to the Medicare Claims Processing Manual, chapter 24. The CR can be found at
http://cms.hhs.gov/Transmittals/downloads/R615CP.pdf
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