Summer 2009

835 ERA improvements scheduled

Blue Cross and Blue Shield of Florida (BCBSF) has scheduled system changes in 2009 to enhance all remittance advices with a focus on the 835 Electronic Remittance Advice (ERA). The enhancements are part of our commitment to continuous improvement in the quality and usability of the 835 ERA.

By the end of July, BCBSF will return the National Drug Code (NDC) and NDC quantity on the 835 when it is submitted on the 837 claim and used to process/price that claim.

• NDC will be found in Loop 2110, Segment SVC, Data Element 01-02 with a qualifier of N4.

• NDC quantity will be found in Loop 2110, Segment SVC, Data Element 05.

During the third quarter, remittance advices will come from a single source disbursement file (SSDF) and the same business rules will apply to all. BCBSF is redesigning all our remittance advices (electronic, online and paper) to provide precise, uniform information. Implementation of the SSDF will eliminate differences between electronic and paper remittances, which will result in increased accuracy, consistency and a reduction in the number of CSCA and PIA7 adjustments.

We are also modifying Forward Balance provider level adjustments to include the beginning and ending balance with an invoice reference number as described in the 835 Implementation Guide. Currently, these adjustments include the patient account number and date of service.

The SSDF will serve as the foundation for a new set of reconciliation tools, which will be available through the Availity^®1 Health Information Network, to assist with managing your accounts receivable. Availity is developing additional financial services, and you will be notified when these capabilities are available to you.

If you have any questions about the NDC or Forward Balance updates as it relates to your particular system, contact your clearinghouse or software vendor.

Future communications related to 835 will be sent via email. Please send your email address and contact information to 835Communications@bcbsfl.com to ensure receipt of updated information. If you submit claims on behalf of multiple providers, please forward the valid email address(es) for the physician(s) and/or provider(s) you represent to 835Communications@bcbsfl.com. You may also send updates (additions/deletions/revisions) to the same email address.