Wednesday, July 2, 2014

Pacific Blue Cross - Bulletin

Dental Claim Issues

Recently, some dental claims to Pacific Blue Cross have been rejected due to incorrect patient ID numbers.

When entering numbers into the Policy and Member ID fields, enter Policy/ID numbers exactly as they appear on the ID card presented, and include any leading zeroes.

Old card (sample only):
Enter D001234 in the Policy # field
Enter 123456789 in the Member ID field                    
New card (sample only):
Enter 123456 In the Policy # field
Enter 00012345 in the Member ID field

Here are some other reasons for rejected claims and how to avoid them:

Incorrect Policy and/or ID numbers
Remind patients to bring their most current ID Cards when confirming dental appointments.*

Obsolete Group and ID numbers
If they don’t have a new ID card, submit claims using your patients’ most recent Policy/ID numbers issued prior to April 4, 2014.

Claim includes combination of old/new numbers
Do not combine old and new ID card numbers when making a claim

Mismatched COB information
Make sure Policy and ID numbers correspond to the correct COB plan.

Policy and ID numbers are entered into the wrong form fields on paper claims 
Check that you have entered Policy and ID numbers in the correct fields on paper claim forms. Update your dental software.

*Dental Providers can also verify new member IDs from provider statements, by signing into PROVIDERnet or by asking patients to sign into CARESnet or CARESnet Mobile to download their new ID cards.

Click here for the official PBC release

ClearDent Support | 1-866-253-2748 x 2

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