Community

Selecting the correct Blue Cross Blue Shield payer

Blue Cross Blue Shield is a payer with unique claim filing rules, so we've put together a comprehensive guide that will help you determine which payer to submit your claims to when your client is covered by a BCBS plan.

Always file out-of-state BCBS claims to your local BCBS Plan

The general rule of thumb is to always file electronic claims to your local BCBS payer. This means that although you may have a client with out-of-state coverage, you will need to submit their claims to your local BCBS in order for them to be successfully processed.

Example: Your client is covered by BCBS of Hawaii, but your practice is located in California - where you are credentialed. The claim must be submitted to your local BCBS of California for processing. 

Note: If a claim is submitted to an out-of-state payer, it may remain in a purgatory "accepted" state. However, it will ultimately receive a rejection since the out-of-state BCBS will not have your credentials (Tax ID/NPI) listed in their provider database.

When a claim is submitted to your local BCBS, they have an internal electronic claim routing system which transmits the claims directly to the appropriate sector for processing based off of the client's member ID number and alpha-prefix.

Submitting to your local BCBS

In order to have a claim sent to your local BCBS payer electronically, you will need to add the local payer to your client's Billing and Insurance Info settings as their primary insurer prior to the creation of the claim:

localbcbs.simplepractice.editinfo.png

localbcbs.simplepractice.addpayer.png

FEP Plans

The same is true if you're trying to file claims to the Federal Employee assistance Program (FEP). You will want to be sure to file your FEP claims to your local BCBS payer as well.

Important: There are two exceptions to this rule. If your client has an FEP plan through the states Michigan or Connecticut, use the payer IDs MIFEP and C2BLS respectively.

FAQ

Q. How do I determine who my local BCBS payer is if there is more than one BCBS in my state? 

A. You will want to ensure that you are submitting claims to whichever BCBS sector you are credentialed/paneled with. If you have any questions about this, reach out to the payer directly by calling their Provider Services number and request more information about where your claims need to be submitted. Our team can help with selecting the appropriate Payer ID once you know which sector you're credentialed with.

Q. I understand I should only file BCBS claims to the local branch, but what about enrollments?

A. You will only need to submit enrollments to your local BCBS payers. There is no need for you to enroll with other out-of-state BCBS payers. This is true for Payment Reports, as well. Out-of-state BCBS plans can send ERAs to your SimplePractice account through an active enrollment connection with your local BCBS.

Q. What payer ID do I use for Excellus Blue Cross Blue Shield?

A. This particular BCBS plan will be determined based on your location, so we've put together another guide to help with: Selecting the appropriate Payer ID for Excellus BCBS plans.

Have more questions? Submit a request