InfoDial User Guide - Blue Cross Blue Shield of Massachusetts by pengxuebo

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									                                                                                                                             InfoDial User Guide


InfoDial User Guide

In an effort to provide you with the most up-to-date information, BCBSMA revises this online manual
throughout the year. The online version is always the most up-to-date version of the manual. Please see the
Summary of Changes document on BlueLinks for Providers for a list of recent revisions.


For information about:                                                                                                       See page:
InfoDial Menu (updated 02/11) ....................................................................................................... 2
Getting Help..................................................................................................................................... 3
   TO CHANGE YOUR PASSWORD (PCPS AND AUTHORIZED SPECIALISTS ONLY) ........................... 3
Determining Medical Eligibility ...................................................................................................... 4
   MEDICAL ELIGIBILITY ................................................................................................................ 4
Determining Medical Eligibility ...................................................................................................... 5
Submitting a Referral....................................................................................................................... 6
Submitting a Referral....................................................................................................................... 7
Recording a Member Visit (physicians only) .................................................................................. 8
Inquiring About a Referral............................................................................................................... 9
Submitting an Outpatient Authorization Request .......................................................................... 10
Outpatient Authorization Type Table ............................................................................................ 12
   DESCRIPTION ............................................................................................................................ 12
   WHEN TO USE THESE CODES ..................................................................................................... 12
Submitting an Inpatient Authorization Request............................................................................. 13
Outpatient Authorization Inquiries ................................................................................................ 15
Inpatient Authorization Inquiries ................................................................................................... 16
Inquiring About a Claim’s Status (updated 02/2010) .................................................................... 17
Submitting 1500 Claims (medical or behavioral health) ............................................................... 20
Canceling a Transaction................................................................................................................. 24
Helpful Hints.................................................................................................................................. 25
   MEDICAL ELIGIBILITY .............................................................................................................. 25
   MAILING ADDRESSES FOR CLAIMS .......................................................................................... 26
   CLAIM STATUS INQUIRY ........................................................................................................... 27
   CLAIM ENTRY ........................................................................................................................... 29


Version 06/11




                                                                                   1
                                                                                                                                       Blue Book 2010-2011
                    InfoDial User Guide


InfoDial Menu




                2
                    Blue Book 2010-2011
                                                                                     InfoDial User Guide


Getting Help
Step-by-step instructions
     If you’re already in InfoDial and you want help, just:
            Press 0 and # to return to the Main Menu.
            Press 5 and follow the steps below to speak to a Provider Services Associate.

     When InfoDial asks you for:        Press:

     Your provider type                 1   If your inquiry is about a Federal Employee
                                            Program (FEP) Member
                                        2   If you are an out-of-state provider
                                        3   For all others

     Type of inquiry                    1   If your inquiry is about an FEP Member
                                        2   If you are an out-of-state provider
                                        3   For all others

     Your provider ID                   Enter your National Provider Identifier (NPI).

     Claims or benefits questions       1   For claims
                                        2   For benefits and eligibility

     Member ID                          Enter the Member ID number for the Member you are
                                        calling about

     Your provider type                 1   If you are a professional provider
                                        2   If you are an institutional provider (hospital or
                                            health care facility)
                                        3   If you are an ancillary provider (including
                                            behavioral health)
                                        4   If you are a dentist

     Note: If you enter a valid NPI, you will not be asked for your provider type.




To change your password (PCPs and authorized specialists only)
     PCPs and authorized specialists submitting referrals and authorizations will require an
     InfoDial password. If you do not know your password, call 1-800-266-2206 and select Option 4
     for assistance.




                                                  3
                                                                                  Blue Book 2010-2011
                                                                                      InfoDial User Guide

Determining Medical Eligibility
Medical Eligibility
     You may determine medical eligibility for Members of HMO Blue®, Blue Care® Elect, Medex®´,
     BCBSMA New England Health Plans, Federal Employee Plan (FEP) Members who are
     Massachusetts residents, and enrollees of local national accounts. InfoDial eligibility is available year-
     round, 24 hours a day, 7 days a week. Information obtained from InfoDial is not an authorization
     of payment.

Step-by-step instructions
     Important reminder: Press the # key after each entry to expedite the transaction. Select 0 and # key at
     any time during the transaction to return to the main menu.

     Step:    Action:

     1        From the main menu, select Option 1 for eligibility.
     2        Select Option 1 for medical eligibility.
     3        Press 9 for “yes” to hear recent updates and helpful hints. Or, press 1 to enter the
              Member’s ID number.
     4        Enter the Member’s 9- or 11-digit ID number. For FEP Members, enter the
              9-digit ID number starting with the letter R; R=*72 (e.g., *7212345678#). NOTE: If the
              Member’s ID number is other than 9 or 11 digits, InfoDial cannot complete your
              transaction. You will be given an opportunity to speak with a Provider Services
              associate.
     5        Enter date of service in MMDDYY format. For example, for January 2, 2008, enter
              010208 OR press the # key for today’s date. (Reminder: eligibility information is
              Member and service date-based.)
     6        Enter the patient’s date of birth in MMDDCCYY format. For example, for May 31,
              1958, enter 05311958.
     7        You will hear medical plan eligibility information.
              Note: You have additional informational options available:
              • For Member, subscriber, and primary care provider (PCP) names, you may choose to
                 have the name spelled—press 6 for no, or press 9 for yes.
              • You have the option to listen to copayment information at the prompt. Press the
                 appropriate key:
              1—For medical copayments
              2—For emergency copayments
              3—For community behavioral health copayments
              4—To hear routine/preventive care copayments
              5—For pharmacy copayments
              Note: If a copayment category is not applicable to a Member’s coverage, you will not
              hear it listed as an option. You will be given the option to speak with an associate if
              copayment information is not found.




                                                     4
                                                                                      Blue Book 2010-2011
                                                                                       InfoDial User Guide


Determining Medical Eligibility

Step-by-step instructions (continued)


     Step:   Action:


     8       Press the appropriate key for your next option:
             1—To repeat PCP information
             2—To repeat Member eligibility
             3—For dependent information under this identification number
                and for the date of service entered (you’ll be taken back to Step 6)
             4—To enter another eligibility (you’ll be taken back to Step 4)
             5—Go back to the Main Menu.




                                                   5
                                                                                       Blue Book 2010-2011
                                                                                       InfoDial User Guide

Submitting a Referral
(for use by PCPs and authorized specialists only)

Step-by-step instructions
Referrals for physician specialist services allow up to 99 visits within 365 days. Using this transaction
you may request up to 8 visits within a calendar year for physical and occupational therapy services and
30 visits for speech therapy services. For a list of BCBMA referral and authorization requirements, see
the Referral and Authorization Quick Tip by logging on to bluecrossma.com/provider. It is available in
the Resource Center>Admin Guidelines & Info> Quick Tips.
        Note: You will need to enter your InfoDial password to complete this transaction.
              If you do not know your password, call 1-800-266-2206 and select Option 4 for
               assistance.
        Important reminder: Press the # key after each entry to expedite the transaction. Select 0 and # key at
        any time during the entry of information to return to the main menu.

        Step:   Action:

        1       From the main menu, select Option 2 for managed care.
                Select Option 2 for submission.
        2

        3       Select Option 1 for PCP referral.
                Enter the referring provider’s 10 digit National Provider Identifier (NPI).
        4
        5       Enter your password (or call 1-800-266-2206 and select Option 4 if you don’t
                know your password).
                Enter the Member’s 9- or 11-digit ID number.
        6
                Enter the Member’s date of birth in MMDDCCYY format. For example:
        7       January 1, 1953 is 01011953. (You will hear this prompt only if the 9-digit ID
                was entered in Step 6.)
                InfoDial will ask if the Member has other insurance. Press 6 for No, or
        8       press 9 for Yes.
                Enter the specialist’s 10-digit National Provider Identifier (NPI).
        9       You will be asked to identify what type of provider you are referring your patient
                to:
                    -Press 1 for physician specialist
                    -Press 2 for facility or other provider type.
        10      If you pressed 2 in Step 9, enter one of the following for the type of referral
                1—Physical therapy
                2—Occupational therapy
                3—Speech therapy.




                                                      6
                                                                                       Blue Book 2010-2011
                                                                                   InfoDial User Guide

Submitting a Referral
Step-by-step instructions

     Step:   Action:


     11      Enter the ICD-9 diagnosis code or press the # key.

             (Note: When you enter any referral on any of the technologies, we encourage
             you to use diagnosis codes. In particular, the use of a diagnosis code for
             referrals submitted for these services will expedite the claim’s processing:
             cardiology, fractures, glaucoma, gold injections, infertility, nephrology with
             diagnosis of end-stage renal disease (ESRD), and ultraviolet light treatment.)

     12      Enter the start date in MMDDCCYY format. For example, January 1,
             2009 would be entered as 010109. If the start date is today’s date, press the #
             key.

             For retro-referrals, the start date should be the actual date of the specialist’s
             visit and no greater than 90 days prior to this transaction’s date of entry.

     13      Enter the number of visits.

     14      InfoDial will repeat the referral information entered, and then ask you to
             confirm its accuracy.

             Press 6 for No, or press 9 for Yes.

             If you press 6, choose from the following:

             1—For Edit (Each entry will be recited. If incorrect, re-enter. Otherwise, press
             the # key. You must take some action; if nothing is done, the transaction will be
             terminated).
             2—For Restart (This will take you back to Step 4 where you will start over
             again re-entering all referral information).
             3—To return to the Managed Care Menu. (Your entry will be voided).

     15      InfoDial will give you a certification number.

     16      Press * to repeat the certification number recited in Step 15.

     17      Press 0 and the # key to return to the main menu.




                                                   7
                                                                                   Blue Book 2010-2011
                                                                               InfoDial User Guide

Recording a Member Visit (physicians only)

Step-by-step instructions (updated 06/11)
     When you “Record a Patient Visit” at the time services are being rendered, the transaction will
     verify the managed care Member’s eligibility in addition to validating that an open and active
     referral is on file for the Member.

     Note: Make sure you use this function only when the Member is present and ready to be treated.

     Important reminder: Press the # key after each entry to expedite the transaction. Select “0” and
     the # key at any time during the entry of information to return to the main menu.

     Step:   Action:


     1       Press 2 for managed care.

     2       Press 1 to record a Member visit.

     3       Enter your National Provider Identifier (NPI).

     4       Enter the patient’s 9- or 11-digit ID number.

     5       Enter the patient’s date of birth in MMDDCCYY format
             Example: January 2, 2008 is 01022008
             (You will be prompted to enter only if the 9-digit ID was entered in Step 4.)

     6       Press the appropriate number below:

             1—Primary care provider (PCP) visit (annual or other visit)
             2—Referral visit
             3—Annual or other visit.




                                                 8
                                                                               Blue Book 2010-2011
                                                                                   InfoDial User Guide

Inquiring About a Referral
Step-by-step instructions
     Important reminder: Press the # key after each entry to expedite the transaction.
                         Select “0” and the # key at any time during the entry of information to
                         return to the main menu.

     Step:   Action:


     1       From the main menu, select Option 2 for managed care.

     2       Select Option 3 for inquiry.

     3       Enter the Member’s 9- or 11-digit ID number.

     4       Enter the Member’s date of birth in MMDDCCYY format.
             Example, if the patient’s birthday is May 31, 1967, enter it as
             05311967. (You will be prompted to enter only if the 9-digit ID was entered in
             Step 3.)

     5       Select Option 2 for referral.

     6       Enter the specialist’s or provider’s National Provider Identifier (NPI). Select the
             corresponding number for the type of referral you are inquiring about.

     7       1—For physical therapy
             2—For occupational therapy
             3—For speech therapy
             4—For physician specialist referral.

     8       Referral information will be provided. If there are multiple referrals
             for the same Member, InfoDial will recite only the oldest active
             referral.

     9       Press * to repeat the certification number.

     10      Press 0 (zero) and the # key to return to the main menu.

                  Note: InfoDial will not recite the status of a closed/expired referral.




                                                                                   Blue Book 2010-2011
                                                  9
                                                                                 InfoDial User Guide

Submitting an Outpatient Authorization Request
Step-by-step instructions
     Using the steps below, you will be able to submit an outpatient authorization for a managed care
     Member. For a list of BCBMA referral and authorization requirements, see the Referral and
     Authorization Quick Tip by logging on to bluecrossma.com/provider. It is available in the
     Resource Center>Admin Guidelines & Info> Quick Tips
     Important reminder:
            Press the # key after each entry to expedite the transaction. Select “0” and the #
           key at any time during the entry of information to return to the main menu.
     Step:    Action:


     1        Press 2 for managed care.

     2        Press 2 for submission.

     3        Press 2 for outpatient authorization.

     4        Enter the Member’s 9- or 11-digit ID number.

     5        Enter the Member’s date of birth in MMDDCCYY format
              Example: Jan. 2, 2008 is 01022008.
              (You will be prompted to enter only if the 9 digit ID was entered
              in Step 4.)


     6        Press the appropriate number below to identify the source of notification:

              1—If you are the treating provider, the system will respond with this message:
              “This notification source is not allowed for this type of submission.”
              2—If you are the referring physician (Primary care or authorized specialist)

     7        The following is required depending upon the notification source entered in
              Step 6:

             If the Notification        Then the following is required:
             Source is:
                                        As the treating provider, you are not authorized to initiate the
             1                            submission of outpatient authorizations. The patient’s PCP or
                                          authorized specialist must initiate this transaction.
                                        Your phone number
                                        Referring physician NPI

             2                          Referring physician NPI (you are the patient’s PCP or
                                          authorized specialist)
                                        Your phone number
                                        Vendor/treating NPI



                                                                                 Blue Book 2010-2011
                                                  10
                                                                                 InfoDial User Guide



Submitting an Outpatient Authorization Request
Step-by-step instructions (continued)

     Step:   Action:


     8       Enter 2-digit authorization type code* (see next page for codes).

     9       Enter 3- to 5-digit ICD-9 diagnosis code.

     10      Enter 2- to 5-character ICD-9 procedure code.
             (Optional; press # to skip.)

     11      Enter the 5-character HCPCS code (required for durable medical equipment
             only if Member is enrolled in Medicare Advantage). Press # to skip.

     12      Enter start date in MMDDCCYY format.

     13      Enter end date in MMDDCCYY format.

     14      Enter number of requested visits.


     *Please note: You must use authorization code 23 for physical therapy services performed by a
     contracted, independent physical therapist.

     Physical therapy, occupational therapy, and speech therapy services may be entered as either
     referrals or outpatient authorizations.




                                                                                 Blue Book 2010-2011
                                                 11
                                                                                          InfoDial User Guide

Outpatient Authorization Type Table
Description
        These codes describe the different types of outpatient services patients may receive with
        authorization.

When to use these codes
        Use these codes to submit outpatient authorizations. Select the most appropriate code based on
        the plan and the type of service the patient will receive, and enter the code when InfoDial asks for
        “Type of Authorization.” If the appropriate code is not listed, please call our Clinical
        Coordination Department at 1-800-327-6716.
  For this service:                                          Enter this code:

  Ambulance (Non-emergency)                                  12
  High Tech Radiology- Outpatient Only
  (Including CT/CTA, PET scan, MRI/MRA and                   62
  nuclear cardiac studies)
  Home Health Care (global)                                  30
  Up to 30 visits in 30 days

  Infertility Procedures                                     10
  Nutritional Counseling (up to 6 visits in 365 days)        14
  Occupational Therapy – Inpatient/in home                   17
  Occupational Therapy – Outpatient and                      16
  Contracted Independent OT Providers
  Physical Therapy – Contracted independent                  23
  provider
  Physical Therapy – Outpatient facility                     22

  Physical Therapy – In home                                 24

  Skilled Nursing – In home                                  26

  Speech Therapy – In home                                   28

  Speech Therapy – Outpatient and Contracted                 29
  Independent ST Providers
  Surgical Day Care                                          31

Neuropsychological testing authorization requests cannot be submitted through our electronic technologies. Submit
authorization requests by faxing a completed Neuropsychological Testing Request Form to 1-888-641-5199.

High-tech radiology: to obtain registration category and pre-certification requirements for outpatient High-tech
radiology, please submit an eligibility inquiry. See Utilization Management section of the Blue Book for further
information.




                                                                                           Blue Book 2010-2011
                                                        12
                                                                                  InfoDial User Guide

Submitting an Inpatient Authorization Request
Step-by-step instructions
      Using the steps below, you will be able to submit an inpatient authorization notification.
  Important reminder:
       Press the # key after each entry to expedite the transaction. Select “0” and the #
          key at any time during the entry of information to return to the main menu.
       Step:   Action:

       1
               Press 2 for managed care.

       2       Press 2 for submission.

       3       Press 2 for inpatient authorization.

       4       Enter patient’s 9-or 11-digit ID number. (For FEP
               Members, enter the 9-digit ID number starting with the letter R
               [R=*72, e.g., enter *7212345678#].)

       5       Enter the patient’s date of birth in MMDDCCYY format
               For example: January 2, 2008 is 01022008.
               (you will be prompted to enter only if the 9-digit ID was entered in Step 4).

       6       Press the appropriate number below to identify source of notification:

               1—If you are a hospital or facility
               2—If you are the admitting physician
               3—If you are the PCP.

       7        The following is required depending upon the notification source entered in
                Step 6:
                         If the Notification Source is:        Then the following is required:


                         1 (Hospital or facility)              Hospital or facility NPI Notifying
                                                                 provider’s phone number
                                                               Admitting physician’s NPI

                         2 (Admitting physician)               Admitting physician’s NPI
                                                               Phone number
                                                               Hospital or facility NPI

                         3 (PCP)                               PCP’s NPI
                                                               Phone number
                                                               Hospital or facility NPI
                                                               Admitting physician’s Plan NPI




                                                                                   Blue Book 2010-2011
                                                      13
                                                                                 InfoDial User Guide

Submitting an Inpatient Authorization Request
Step-by-step instructions (continued)
     Step:   Action:


     8       Press the appropriate number to describe the admission type:

             1—for elective
             2—for emergency


     9       Enter the admission date in MMDDCCYY format

     10      Enter the required 3-to 5-character ICD-9 primary diagnosis code.

     11      Enter the 3-to 5-character ICD-9 secondary diagnosis code(s).
             (Optional: press 9 to enter; 6 to skip. May repeat up to eight times for
             additional codes.)

     12      Enter the 2-to 5-character ICD-9 primary procedure code(s)
             . (Optional: press 9 to enter; 6 to skip.)

     13      Enter the 2-to 5-character ICD-9 secondary procedure code(s)
             . (Optional: press 9 to enter; 6 to skip. May repeat up to
             three times for additional codes.)

     14      Enter the procedure date in MMDDCCYY format. (You may enter two
             dates. (Optional: Press 9 to enter; 6 to skip.


     InfoDial will process your authorization and, if accepted, recite a certification number for your
     records. Approval of services may be contingent on clinical review of the case.




                                                                                 Blue Book 2010-2011
                                                14
                                                                                   InfoDial User Guide

Outpatient Authorization Inquiries
Step-by-step instructions
     Using the steps below, you will be able to inquire on the status of a managed care Member’s
     outpatient authorization.

         Important reminder: Press the # key after each entry to expedite the transaction.
                            Select “0” and # key at any time during the entry of information to
                            return to the main menu.

     Step:     Action:


     1         Press 2 for managed care.

     2         Press 3 for inquiry.

     3         Enter Member’s 9-or 11-digit ID number.

     4         Enter the Member’s date of birth in MMDDCCYY format
               For example: January 2, 2009 is 01022009.
               (you will be prompted to enter only if the 9-digit ID was entered in Step 4).

     5         Press 3 for outpatient authorization.

     6         Enter specialist’s NPI.

     7         Press the appropriate number:
               1—For physical therapy                      3—For speech therapy
               2—For occupational therapy                  5—For other services and supplies


     8         If you enter 5 in Step 7, you must enter 10-digit outpatient authorization
                   certification number. If you do not have this information, press 0 (zero) and the
                   # key to return to the main menu; then select 5 to speak with Provider Services.

               Note: InfoDial will process your transaction and provide you with your Member’s
                 authorization status. Authorization information will only be available if a
                 valid/open authorization is found. Closed or history authorization information
                 is not available.




                                                                                   Blue Book 2010-2011
                                                   15
                                                                                       InfoDial User Guide

Inpatient Authorization Inquiries
Step-by-step instructions
     Using the steps below, you will be able to inquire on the status of an inpatient authorization

         Important reminder: Press the # key after each entry to expedite the transaction.
                             Select “0” and # key at any time during the entry of information to
                             return to the main menu.

     Step:       Action:


     1           Press 2 for managed care.

     2           Press 3 for inquiry.

     3           Enter the Member’s 9-or 11-digit ID number.
                 (For FEP Members, enter the 9-digit ID number starting with the letter
                 R [R=*72 e.g., enter *7212345678#].)

     4           Enter the Member’s date of birth in MMDDCCYY format
                 For example, January 2, 2008 is 01022008. (You will be prompted to enter only
                 if the 9-digit ID was entered in Step 4.)

     5           Press 4 for inpatient authorization.

     6           Enter the facility NPI.



      InfoDial will process your transaction and give you the patient’s inpatient authorization
     status.




                                                                                       Blue Book 2010-2011
                                                     16
                                                                                     InfoDial User Guide

Inquiring About a Claim’s Status (updated 02/2010)
Claim status information is available within 48-72 hours if the claim was submitted to us via InfoDial or
any other electronic technology. Claim status is available M–F, 6:30 a.m.–9 p.m., and Sat.–Sun., 7 a.m.–4
p.m.


Step-by-step instructions
        Important reminder: Press the # key after each entry to expedite the transaction.
                            Select “0” and # key at any time during the entry of information to
                            return to the main menu.

        Step:    Action:


        1        From the main menu, select Option 4 for claim status.

        2        Press 9 for “yes” to hear recent updates and helpful hints OR enter the servicing
                 provider’s NPI

        3            The Member’s ID number will be entered in two separate steps;
                     first the alpha prefix (Step 3) and then the remainder of the Member ID
                     number (Step 4).
                      The prefix field is limited to 3 alpha characters. If the alpha prefix has
                          greater than 3 characters, enter the first 3 at this prompt using the
                          conversion table provided below. The remaining alpha/numeric digits
                          should be entered when prompted for the ID number (see Step 4).
                      If the Member’s ID number begins with XX, MTN or MTP it is not
                          necessary to enter the prefix. Press the # key to skip this step.
                      If the Member’s ID number begins with any other prefix this step is
                          mandatory and the prefix should be entered using the conversion table
                          provided.
                              o Federal Employee Program Member ID cards have an alpha
                                   prefix of a single letter R. At the prompt, enter *72 followed by
                                   the # key.)
                      After entering the prefix, enter # and you will be prompted to enter the
                          remainder of the ID number (see Step 4).

                  Example:       For Member ID #: MKK 123A45678,
                                 the prefix would be entered as *61*52*52#



                 Refer to the alpha conversion chart below :




                                                                                     Blue Book 2010-2011
                                                    17
                                                                                 InfoDial User Guide

Inquiring About a Claim’s Status
            How to Enter Letters on InfoDial
             For this letter:   Enter this code:     For this letter:   Enter this code:
                   A                  *21                  N                  *62
                   B                  *22                  O                  *63
                   C                  *23                  P                  *71
                   D                  *31                  Q                  *11
                   E                  *32                  R                  *72
                    F                 *33                  S                  *73
                   G                  *41                  T                  *81
                   H                  *42                  U                  *82
                    I                 *43                  V                  *83
                    J                 *51                  W                  *91
                   K                  *52                  X                  *92
                   L                  *53                  Y                  *93
                   M                  *61                  Z                  *12


    Step:   Action:


    4       Enter up to 10 characters of the Member’s ID number. Please enter these
            characters as they appear in the Member ID card following the alpha-prefix. Press
            the # key when done.
            Most Member ID numbers contain only numeric digits, however when an ID does
            contain an alpha character, convert that alpha character to a number using the
            provided conversion table.

            Example : For Member ID #: MKK123A45678, the Member ID after the prefix
                        would be entered as 123*2145678 then press the # key.


    5       Enter the total charges of the claim, including dollars and cents.
            For example, if the total charges are $600.00, enter “60000”.
            If the total charges are $50.25, enter”5025”.

    6       Enter the first date of service that was reported on your claim when submitted in
            MMDDCCYY format. For example, for January 15, 2009, enter 01152009.

    7       The claim’s status and the Plans’ address information will be provided.




                                                                                 Blue Book 2010-2011
                                                18
                                                                                InfoDial User Guide

Inquiring About a Claim’s Status

    Step:   Action:

    8       To check the status of multiple claims, you have two options:
            – Press 0 (zero) and the # key to return to the main menu.
            – Press 4 to begin the claim status inquiry again. InfoDial
              will prompt you to enter your servicing provider NPI and the patient’s ID
              number.

            The following inquiry options will also be offered to which you can:
            – Press 6 for no
            – Press 9 for yes

                 Would you like to inquire about another claim for the same certificate
                  number for the same servicing provider? (You’ll be taken back to Step 5.)

                 Would you like to inquire about another claim for the same servicing
                  provider using a different Member certificate number? (You’ll be taken back
                  to Step 4.)

                 Would you like to inquire about another claim using a different servicing
                  provider NPI? (You’ll be taken back to Step 2.)

            If you respond with a “no” to all of these questions, InfoDial will automatically
            return you to the main menu.




                                                                                Blue Book 2010-2011
                                                19
                                                                                         InfoDial User Guide

Submitting 1500 Claims (medical or behavioral health)
Step-by-step instructions
     Using the steps below, you can submit a CMS-1500 claim form for our Members when we are the
     primary insurer. The ideal time to enter claims via InfoDial is M-F, 6 a.m.–9 p.m., and Sat.–Sun.,
     7 a.m.–4 p.m. You may experience difficulty with claim entry when our systems are being
     updated.

              Claim entry will be accepted only if the Member has an active “medical” policy.
              BlueCard Program/out-of-state claims are not eligible for claim entry via InfoDial.
              If your charge on any line exceeds $9,999.99, you may not submit your claim via InfoDial.
              Info-Dial has a claim entry maximum of 10 lines per claim. If you need to submit
               additional lines, the system will direct you after providing a confirmation number for the
               previously approved lines entered.

         Important reminder: Press the # key after each entry to expedite the transaction.
                             Select “0” and # key at any time during the entry of information to
                             return to the main menu.

     Step:       Action:
     1           Press 3 for claim entry.

     2           Press 1 for regular business claim entry (BCBS).

     3           Press 9 for helpful hints or enter your group or billing NPI. If your NPI maps to
                 multiple provider legacy numbers, you will be asked to enter the appropriate
                 legacy number to ensure accurate claims processing.

     4           Enter the leading letter(s) on Member’s ID card, including the letter R (R=*72,
                 e.g., enter *72) for FEP Members. (If the card starts with XX, MTN, or MTP,
                 you may press the # key). See the alpha conversion chart below.

                 How to Enter Letters on InfoDial
                 For this letter:    Enter this code:        For this letter:   Enter this code:
                       A                   *21                     N                  *62
                       B                   *22                     O                  *63
                       C                   *23                     P                  *71
                       D                   *31                     Q                  *11
                       E                   *32                     R                  *72
                        F                  *33                     S                  *73
                       G                   *41                     T                  *81
                       H                   *42                     U                  *82
                        I                  *43                     V                  *83
                        J                  *51                     W                  *91
                       K                   *52                     X                  *92
                       L                   *53                     Y                  *93
                       M                   *61                     Z                  *12




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                                                                                                InfoDial User Guide

  Submitting 1500 Claims to Us (medical or behavioral health)
  Step-by-step instructions
                           Step:    Action:


                           5        Enter Member’s 8- or 9-digit ID number. (Do not include the 2-digit
                                    suffix.)

                           6        Enter your Member account number (up to 10 digits) that your office has
                                    assigned, or press the # key to skip.

                           7        Enter the first five letters of the Member’s FIRST name (enter the number
                                    corresponding to the letter on the key pad [i.e., MARY = 6279]).
                                    Exception: If there is a “Z” or “Q” in the Member’s first name, use the
                                    number 1 key. For example, Zachery would be 12243. Additionally, if a
                                    Member’s name is hyphenated, or contains a space, enter the five letters
If a Member’s first name is a       omitting the hyphen and space. For example, Jean-Louise would be 53265.
single initial followed by a
middle name, enter the
first five letters omitting the          How to Enter a Patient’s Name on InfoDial
space. For example, A Jean          For this letter:   Enter this code:      For this letter:      Enter this
would be 25326.                                                                                     code:
Additionally, if a Member                  A                     2                 N                   6
has a hyphenated or two-                   B                     2                 O                   6
part first name, enter the                 C                     2                 P                   7
first five letters omitting the            D                     3                 Q                   1
hyphen/space. For example,                 E                     3                 R                   7
Mary Jo would be 62795                     F                     3                 S                   7
and Jean-Louise would                      G                     4                 T                   8
be 53265. If the member’s                  H                     4                 U                   8
first name contains less than              I                     4                 V                   8
5 letters, press the # key                 J                     5                 W                   9
after you enter the last letter.           K                     5                 X                   9
                                           L                     5                 Y                   9
                                           M                     6                 Z                   1
                               8   Enter the Member’s date of birth in MMDDCCYY format.
                                   Press either:
                            9*     1# if accident-related (or if the first digit of the diagnosis code is 8 or 9);
                                   the system will take you to step 10.
                                   OR
                                   The # key if not accident-related (diagnosis not beginning with 8 or 9); the
                                   system will skip to Step 12.
                                   (If claim is accident-related in Step 9) Choose one:
                            10     1—Employment accident/workers’ compensation
                                   2—Automobile accident
                                   3—Other accident*
  *If the first three digits of the diagnosis are greater than 800, an accident or onset condition date must be reported.
  Please complete steps 9, 10, and 11. To ensure accurate claim payment for the initial treatment of an accident,
  indicate “other” if workers’ compensation or auto is not applicable.




                                                                                                Blue Book 2010-2011
                                                            21
                                                                                 InfoDial User Guide

Submitting a 1500 Claim to Us (medical or behavioral health)
Step-by-step instructions (continued)
     Step:   Action:


     11      If claim is accident-related in Step 9. Enter the date of accident or the condition
             onset date in MMDDCCYY format, for example, allergic reaction to a bee sting.

     12      Enter the 3-to 5-digit diagnosis code. Up to four diagnosis codes may be reported.
             If the first digit of the diagnosis code is 8 or 9, the system will take you back to
             step 9 if the accident related indicator was bypassed.

     13      Enter the date of service in MMDDCCYY format, or press the # key for today’s
             date.

     14      Press appropriate number for place of service:
             1—Inpatient facility                6—Night care facility
             2—Outpatient facility               9—Ambulance
             3—Doctor’s office                 *21 (A)—Independent lab
             4—Patient’s home                   *22 (B)—Ambulatory Medical Center
             5—Day care facility                *53 (L)—DME supplier
     15      Enter a valid procedure code (up to five characters).

     16      Enter the procedure code’s two-digit modifier (if applicable, press the # key to
             skip). A maximum of three modifiers can be accepted.
     17      Enter line charge dollar amount (e.g., $45.00=4500). You may enter no greater
             than six digits (e.g., 9,999.99).
     18      Enter the units of service (can not be less than one)

     19      Enter the diagnosis code pointer. If more than one diagnosis code was entered in
             Step 12, please indicate which diagnosis is to be used for the claim line you are
             now entering. For example, for diagnosis number one, enter 1.

     20      If you used a group billing NPI in Step 3. Enter the individual servicing/treating
             provider’s NPI. If there are multiple legacy numbers mapped to the NPI entered,
             you will be prompted to enter the applicable legacy number to ensure accurate
             claims processing. (Numerical codes representing any letters in your number are
             found in the Helpful Hints section of this guide.. If your servicing provider NPI is
             the same as your billing provider NPI press the # key).
     21      The claim line data entered will be recited back. Press either:
             9—To confirm service line data entered is correct
             6—To edit or delete the line entered




                                                                                 Blue Book 2010-2011
                                                 22
                                                                                InfoDial User Guide



Submitting a 1500 Claim to Us (medical or behavioral health)
Step-by-step instructions (continued)
     Step:   Action:


     22      You must make a selection to either continue to enter your claim or to receive your
             confirmation number if you have completed the entry of your claim(s).
             Press the appropriate number:

             1—Enter another line. (You will automatically go back to Step 13.)

             2—Enter another claim. (You will be given a confirmation number* for the claim
             just submitted before returning to Step 2 to enter another claim.)

             3—You have completed your claim and are ready to receive your confirmation
             number. A claim will not be accepted for processing without a confirmation
             number being assigned.

             InfoDial will automatically return you to the main menu, or you may choose to
             hang up.




     * Once confirmed, the claim information will be passed to our system for processing. This
      transaction cannot be cancelled. If you entered a claim in error, please send Provider Services
      a request to retract payment once you have received a Provider Detail Advisory (PDA) on the
      claim. The Provider Services mailing address can be found in the Helpful Hints section of this
      user guide. It is also available by selecting Option 5 from the InfoDial main menu, press 9 for
      address information and then select 5 for adjustment request.



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                                                23
                                                                                    InfoDial User Guide


Canceling a Transaction

Step-by-step instructions
     IMPORTANT: You may only cancel a referral or recorded visit transaction on the same
     day it is entered.
           Each time you record a managed care Member’s visit, a visit is automatically deducted
               from the applicable referral or authorization. If you enter a visit by mistake, use the
               Maintenance Function to cancel the visit so that the valid number of visits remain on
               file.

              If you submit a referral and later that same day find that you have made an error, use the
                 Maintenance Function to cancel your initial entry and start over.

     Using the steps below, you will be able to cancel a visit or referral transaction

     Step:       Action:


     1           Press 2 on the main menu for managed care

     2           Press 4 for maintenance

                When the InfoDial asks you for:      Enter:


                Type of change                       Either:
                                                     2—to cancel a visit, or
                                                     3—to cancel a referral
                                                     (Inpatient/outpatient authorizations and
                                                     facility referrals for PT, OT, or ST
                                                     services cannot be cancelled)

                Reference number                     10-character reference number of the visit
                                                     10-character certification number of the
                Certification Number                 referral

                Confirm cancellation                 Either:
                                                     9—to cancel the visit or referral
                                                     6—if you do not want to accept this
                                                     cancellation

                 InfoDial will process your request and confirm the cancellation.




                                                                                    Blue Book 2010-2011
                                                   24
                                                                                  InfoDial User Guide

Helpful Hints

Press 9 for InfoDial Helpful Hints

Medical Eligibility
      At any time, you may press:
            —# (pound key) to skip a message
            —* (star key) to repeat the message
            —0 (zero) and # (pound key) to return to the main menu.

      You may access medical eligibility for all of our Members including Medex®,
      Federal Employee Program (FEP) enrollees who reside in Massachusetts, Medicare HMO Blue ®,
      Medicare PPO BlueSM, and New England Health Plan managed care Members who have chosen a
      Plan primary care provider (PCP).

      Medical eligibility information for an active Plan Member includes:
            —Group number
            —Group or non-group enrollment
            —Type of coverage
            —Individual or family certificate
            —The PCP’s name and phone number (for a managed care Member)
            —Common copayment information
            —MRI/CT scan and chiropractic authorization requirements.

      The information provided is dependent upon the Member’s coverage status for the date of service
      requested. The Plan will not cover services related to specific contract exclusions such as
      custodial care, pre-existing conditions, experimental procedures, or care determined not to be
      medically necessary.

      An eligibility inquiry is not a guarantee of claim payment.

      The medical eligibility transaction will prompt for the Member’s ID number. FEP Members have
      a 9-digit number beginning with the letter R. Enter the 9-digit identification number as *72
      followed by the 8 numeric digits (i.e., *7212345678). For all other eligibility inquiries, there is
      no need to enter the 3-letter prefix.

      We do not provide eligibility information for Members enrolled in an out-of-state Blue Cross
      Blue Shield (BCBS) Plan. For membership and coverage information for these out-of-state
      Members, call BlueCardSM Eligibility at 1-800-676-BLUE (2583).




                                                                                  Blue Book 2010-2011
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                                                                                InfoDial User Guide

Helpful Hints

Medical Eligibility (continued)
     When submitting a referral or authorization to another health care provider and you do not know
     the specialist’s or facility’s NPI, please contact them to obtain the correct NPI information. Our
     provider directory contains NPI information and is available to Participating Providers on our
     website. Log on to www.bluecrossma.com/provider and click Manage Your Business>Find a
     Doctor and complete the required fields. When the results display, simply click on the provider’s
     name and NPI information will display.


Mailing Addresses for Claims
     Please use the appropriate mailing address below for paper claim submissions, returned checks,
     and adjustments. This information is also available via InfoDial. From the main menu, select
     Option 5, and then press 9.

                 CMS-1500 paper claims                        BCBSMA
                                                              P.O. Box 986020
                                                              Boston, MA 02298



                 UB-04 paper claims                           BCBSMA
                                                              P.O. Box 986015
                                                              Boston, MA 02298

                 Returned Checks                              BCBSMA
                                                              Cash Receipts
                                                              One Enterprise Drive
                                                              Mail-stop 02/04
                                                              North Quincy, MA 02171

                 Provider Services Adjust Requests            BCBSMA
                                                              Provider Services
                                                              P.O. Box 986065
                                                              Boston, MA 02298




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                                                                                    InfoDial User Guide

Helpful Hints

Claim Status Inquiry
     For Claim Inquiry information on InfoDial, press 1.
     InfoDial’s claim inquiry transaction may be used to find the processing status of any claim that
     was submitted directly to us. If your claim was filed with another state’s BCBS Plan, status
     information is not available via InfoDial. Please contact the other Plan directly.

     Claim status information is available within 48 to 72 hours after a claim has been electronically
     submitted for processing. If a paper claim was submitted, please allow time for your claim to be
     entered into our system.

     Important Note: If we do not have your National Provider Identifier (NPI) on file, we will not be
     able to process this electronic transaction. Please contact us at 1-800-419-4419 so that we may
     update our records with your NPI information.

     For help entering the provider number, press 2.

     InfoDial will prompt you to enter the servicing or treating provider’s National Provider Identifier
     (NPI)*. If you have shared your NPI information with us, we will be able to provide you with
     status information even if the claim was initially submitted using the legacy number. If we do not
     have your NPI on file, you will not be able to perform this electronic transaction. Please call us at
     1-800-419-4419 so that we may update our records with your NPI information


     For help entering the Member identification number, press 3.

     The Member’s ID number will be entered in two separate steps; first the alpha prefix and then the
     numeric portion of the ID number. If the Member’s ID number begins with XX, MTN, or MTP it
     is not necessary to enter the alpha prefix; simply press the # key to bypass this requirement.
     However, all other prefixes must be entered to ensure an accurate inquiry response. This field
     contains up to 3 digits. If the alpha prefix is more than 3 digits, enter the first three in this field
     and enter the remaining alpha/numeric digits in the ID# field.

     Federal Employee Program (FEP) Member ID cards have an alpha prefix of a single letter R. At
     the prompt to enter any prefix letters, press *72 followed by the # key. You must enter the alpha
     prefix for all national and BlueCard Program inquiries.




                                                                                    Blue Book 2010-2011
                                                  27
                                                                                    InfoDial User Guide

Helpful Hints
Claim Status Inquiry (continued)
     To enter the alpha portion of the Member’s ID number, press the # key followed by the
     corresponding alpha key. For example, to enter the letter B, press * followed by 2 and 2. The
     letter B is on the 2 key of your phone key pad and it is in the second position. To enter the letter
     S, press * followed by 7 and 3; for the letter Q press * followed by the 1 and 1; for the letter Z,
     press * followed by 1 and 2.

     How to Enter Letters on InfoDial

      For this letter:   Enter this code:     For this letter:   Enter this code:
            A                  *21                  N                  *62
            B                  *22                  O                  *63
            C                  *23                  P                  *71
            D                  *31                  Q                  *11
            E                  *32                  R                  *72
             F                 *33                  S                  *73
            G                  *41                  T                  *81
            H                  *42                  U                  *82
             I                 *43                  V                  *83
             J                 *51                  W                  *91
            K                  *52                  X                  *92
            L                  *53                  Y                  *93
            M                  *61                  Z                  *12

     For help entering dollar amounts, press 4.
     Enter the total charges of our claim as dollars and cents. For example, $45.50 would be entered as
     4550. If there is a claim matching the criteria entered, but for a different dollar amount, InfoDial
     will advise you of the variance and then provide the found claim’s information and status.

     For Claim Status information provided by InfoDial, press 5.
     InfoDial will give you the status of the claim(s) found: paid, rejected, pending, or no record.

      For a claim that has been:              InfoDial will report the:

      Paid                                    Claim number, claim receipt date, dollar
                                              amount paid, dollar amount deductible applied,
                                              payment date, and check number

      Denied                                  Claim number, claim receipt date, rejection
                                              date, and, in many cases, a reject reason

      Received, but not finalized             Claim number and claim receipt date

     If there is “no record” of your claim processing, please verify the information entered and if
     necessary, resubmit the claim.




                                                                                    Blue Book 2010-2011
                                                  28
                                                                                  InfoDial User Guide

Helpful Hints
Claim Entry

     Important Note: If we do not have your National Provider Identifier (NPI) on file, we will not be
     able to process this electronic transaction. Please contact us at 1-800-419-4419 so that we may
     update our records with your NPI information.

     At any time you may press:
           — # (pound key) to skip a message
           — * (star key) to repeat the message
           — 0 (zero) and # (pound key) to return to the main menu.

     For General Information about Info-Dial’s Claim Entry functionality, press 1.

     InfoDial’s claim entry transaction allows Participating Providers to submit the CMS-1500 claim
     format for Members when we are the primary insurer. At the time of the claims entry into Info-
     Dial, the Member must have an active Plan medical policy.

     If you are not sure of the Member’s eligibility status for the date of service you are submitting,
     you may verify the Member’s enrollment by selecting Option 1 (eligibility) from the InfoDial
     main menu. If the Member does not have an active medical policy for the date of service being
     reported on the claim, the transaction will not be accepted.

     Claims entered prior to 2 p.m. will be available for claim status inquiry on the next business day.
     For claims entered after 2 p.m., please allow 48 to 72 hours for inquiry availability.

     For out-of-state Members and Plan secondary claim submission information, press 2.

     BlueCard Program claims are not eligible for claim entry via InfoDial. If you must submit a paper
     claim, please send it to:

     BCBSMA Data Capture
     P.O. Box 986020
     Boston, MA 02298




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                                                  29
                                                                                      InfoDial User Guide



Helpful Hints

Claim Entry (continued)
     Secondary Plan claims are not eligible for submission via the InfoDial system. If you have no
     other electronic means of claim filing available to you, please mail a paper claim with a copy of
     the primary insurer’s explanation of benefits attached to:
           BCBSMA Data Capture
           P.O. Box 986020
           Boston, MA 02298
     For help with entering the provider number, press 3.

     Important Note: If we do not have your National Provider Identifier (NPI) on file, we will not be
     able to process this electronic transaction. Please contact us at 1-800-419-4419 so that we may
     update our records with your NPI information.

     InfoDial will first ask for your group or billing National Provider Identifier (NPI); this identifies
     to whom the payment is to be issued. The system will prompt you to enter the servicing/treating
     provider’s NPI if this information is needed. If your NPI is mapped to multiple legacy numbers,
     you will be asked to enter the appropriate legacy number to ensure accurate claims processing.
     For help with entering the Member identification number, press 4.

     The Member’s identification number will be entered in two separate steps; first the alpha prefix
     and then the numeric portion. If the prefix begins with XX, MTN or MTP you may press # (the
     pound key) to bypass the entry. For all others, the prefix portion of the identification number will
     require conversion to a numeric format. Press * (the star key) and then the corresponding alpha
     key. For example, to enter the prefix R, press *72. For the letter M, enter *61; the letter M is on
     the number 6 key of your phone pad and it is in the first position. Please see the alpha conversion
     chart on page 32 of this guide.

     For help with entering the patient’s first name, press 5.
     When asked to enter the first five letters of the patient’s first name, press the single key on which
     the letter is displayed. For example, Mary is 6279. If the Member’s first name contains a Q or Z,
     please press the number 1 key where applicable. Elizabeth would be entered as 35412. If a
     patient’s first name has a space such as Jo Anne, omit the space and enter the first five letters;
     56266. This process would also apply to any hyphenated first names. If the member’s first name
     is less than 5 letters, press the # key after entering the last letter.
     For help with entering the diagnosis code, dollar amount, or units of service, press 6.

                 If the diagnosis code is greater than 800, an accident indicator must be reported. The
                 date of the accident is the date of the injury or the onset of the condition. This
                 information is critical to accurate claims processing. Only valid diagnosis codes will
                 be accepted. If the code contains an alpha character, it will require conversion to a
                 numeric format. For example,
                 V would be entered as *83.




                                                 30                                Blue Book 2010-2011
                                                                                     InfoDial User Guide



Helpful Hints

Claim Entry (continued)

     Enter dollar amounts as dollars and cents. For example, $45.50 would be entered as 4550; $80
     would be entered as 8000.

     Units of Service is a required field and must be reported as no less than “1.” Enter the units of
     service rendered for the procedure code being reported.

     For claim validation and confirmation information, press 7.

     Once all of the data for the line of your claim has been entered, InfoDial will then recite the
     information for your confirmation before proceeding with the entry of an additional line or
     another claim. If any of the information entered is incorrect, you will have an opportunity to back
     up and make the necessary corrections. In order for a claim to be accepted and forwarded for
     processing, you must make a selection to either enter another claim or indicate that you have
     finished the claim entry transaction.

     Once you’ve indicated the claim entry is complete, a confirmation number will be given. The
     claim will then be forwarded for processing. If you do not receive a confirmation number, the
     data entered will not be accepted as a claim. Once a confirmation number is assigned, the claim
     entry transaction cannot be cancelled. If a claim was submitted in error, please contact Provider
     Services after the claim has finalized and request a retraction.




                                                 31                               Blue Book 2010-2011

								
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