Claims Filing

When filing a claim with Blue Cross and Blue Shield of Florida (BCBSF) for BlueMedicare PFFS, health care providers should bill using the same data elements as they would for Medicare.

Providers are encouraged to submit claims within 30 days of the service date, although Medicare guidelines allow longer. Failure to complete all required information could result in the claim rejecting, payment delays, and/or additional development requests. Please refer to claims submission guidelines below.

Electronic Claims

Submit claims electronically through the Availity^® Health Information Network or through a billing service or clearinghouse to transmit to Availity; Availity will route to BCBSF. For submission requirements, refer to www.availity.com.

Availity Technical Support Questions
and Assistance: 1-800-Availity (282-4548)
BCBSF Technical Support (EDI Support): 904-905-6314

Paper Claims

• Use the UB-04 or CMS-1500 claim form (or electronic equivalent, the HIPAA compliant X12 EDI 837).
• Submit paper claims to:
  Blue Cross and Blue Shield of Florida
  PO Box 1798
  Jacksonville, FL 32231-0014

BCBSF Provider Services:

For questions and/or information regarding general claims call the Provider Contact Center at 1-800-727-2227.

Important CMS-1500 Claim Form Information

As of July 1, 2007 Medicare no longer accepts any 12-90 version CMS-1500 claim forms received. BCBSF relies on the Medicare claims reimbursement guidelines and methodologies. Therefore, any claim forms we receive that are not on the CMS-1500 (08-05) version will be returned.

Important UB-04 Claim Form Information

As of May 23, 2007 Medicare no longer accepts the UB-92. BCBSF relies on the Medicare claims reimbursement guidelines and methodologies. Therefore, any claim forms we receive that are not on the UB-04 form will be returned.

Claim Status Terms

Clean Claim: A claim filed with all the information necessary to pay the claim without delay.
Paid Claims: Clean claims are processed within 10-14 days.
Denied Claims: Services indicated on the submitted claim are not covered or the member is not eligible.
Pended Claims: Unable to pay the claim due to missing information or because it requires a manual review.

W-9 Contact Information

It is essential that your W-9 form be completed properly to ensure we have your correct contact information. The information you provide to us on your W-9 should match the information sent to the IRS. To avoid penalties, it is crucial you provide name(s) and TIN(s) that match the IRS' records. Please be sure to complete your W-9 as follows:

When filing a claim, failure to complete all required information could result in the claim rejecting, payment delays, and/or additional development requests. Please refer to claims submission guidelines below.

• Electronic (Availity) and Paper Claims Submission Guidelines (PDF)

BlueMedicare PFFS has a Medicare Advantage contract approved by the Centers for Medicare & Medicaid Services. Contracts are renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. A doctor or hospital must agree to accept the plan's terms and conditions prior to providing health care services to a member, with the exception of emergencies. If a doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to the member, except in emergencies.