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When is the deadline
for submitting claims in the old format? |
Paper Claims, including regular,
adjustment, and appeals, must be received at CBH by 5:00 PM on
February 6, 2004
Electronic Claims must be received at CBH by 9:00 AM
on February 16, 2004 |
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What are the benefits of electronic filing?
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Filing claims
electronically helps providers minimize data entry errors after
submission, ensure information is legible and expedite the
processing of their claims. |
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Will CBH continue to accept paper claims?
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Yes, but after
February 6, 2004, paper claims must include HIPAA compliant billing
codes or the claim will be returned for correction before the claim
will be processed. |
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Can I send in my claims on diskette? |
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CBH will be
phasing out the use of floppy disks for electronic claims submission
in favor of our new browser interface. Providers who are currently
sending disks must adopt the new method as soon as possible. If you
can change to using the browser interface prior to being qualified
in HIPAA compliant transactions, please do so. If you will be
unable to do so, contact your Provider Representative, who can
assist you in making the transition. |
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Can I still use Coffee Cup FTP? |
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No, beginning
February 17, 2004, all providers utilizing EDI must use the browser
interface to submit claims. |
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Are there HIPAA compliant billing code
requirements for electronic claims submissions? |
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Yes. Beginning
February 17, 2004, all electronic claims submissions must include
HIPAA compliant billing codes in order to be processed. CBH has
posted to the website a code list crosswalk to assist you with this
transition. |
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What is
a clearinghouse? |
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A
clearinghouse is a company that takes claims information from any
doctor, hospital, etc., and sends claims to payers on paper or as
electronic files. Large clearinghouses usually have many
subsidiaries. |
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Can a provider of any size file electronic
claims? |
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Yes, any
provider capable of creating a HIPAA formatted EDI transaction can
send claims to CBH once the TPA and testing requirements have been
met. |
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What happened to the CBH Modifier?
What is the Blanket Authorization Number (BAN)? |
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To minimize
confusion with the Pricing and Information Modifiers and to ease
data collection, CBH has changed the field name and the numbering
system which identify unauthorized services. Now each unauthorized
service has a designated Blanket Authorization Number or BAN. The BAN is not contingent on provider
type but is instead unique to the CBH Level of Care in combination
with the Procedure Code and Pricing and Information Modifiers. BANs and their corresponding Level of Care information may be viewed
on this site in the revised
CBH Level of Care HIPAA Codes. Providers must refer to their
Schedule A Forms for appropriate billing combinations, including BANs. |
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Where do I put Blanket Authorization
Number (BAN) on a 837P or 837I transaction claim? |
CBH issues two types
of authorizations; blanket authorizations and authorizations that
the provider must ask CBH to approve (prior authorization).
The 837 has two levels that authorizations can be sent in at; the
claim level and the claim line level.
Authorizations that apply to the all (or most) of the services in a
claim would be sent at the claim level in the 2300 REF segment with
REF01 = “G1”. Claim level
authorizations could be either blanket authorization or prior
authorizations. Authorizations that only apply to a specific claim
line would be sent at the service line level in the 2400 REF segment
with REF01 = “G1”. Claim line authorizations could be either blanket
authorization or prior authorizations.
In the event that the provider needs to send both claim and claim
line level authorizations, the provider would send the authorization
that applies to most of the services in the claim in the 2300 REF
segment with REF01 = “G1” with the actual authorization number in
REF02, and the provider would then send the authorization that
applies only to the claim line in the 2400 REF segment with REF01 =
“G1” with the actual authorization number in REF02.
For example, if a claim had 3 service lines and there is a blanket
authorization in the claim level 2300 REF, that authorization
applies to all the claim lines except the second claim line when
there is a service line level 2400 REF with the prior authorization
for that second claim line. The blanket authorization would apply to
the first and third service lines and the second line would have the
prior authorization applied only to that second claim line.
Another example could be where the opposite is true. If a claim had
3 service lines and there is a prior authorization in the claim
level 2300 REF, that authorization applies to all the claim lines
except the second claim line when there is a service line level 2400
REF with the blanket authorization for that second claim line. The
prior authorization would apply to the first and third service lines
and the second line would have the blanket authorization applied
only to that second claim line. |
