What Steps must be completed by Providers who wish to render services for Elderly Waiver Secure Blue and Blue Advantage Members?
- Providers must be registered with DHS and have a service agreement in order to perform the services for members who are on the Elderly Waiver program.
- Providers must continue to meet the specific standards, licensing, certification and registration requirements as outlined by the Minnesota Department of Health in the Elderly Waiver (EW) Program information.
- Provider must register with the Availity Essentials clearinghouse at www.Availity.com to submit claims to the Bridgeview Company.
- Providers must register with an UMPI (Unique Minnesota Provider Identifier) or NPI (National Provider Identifier) and
- Providers must register with FEIN/TIN (Business Federal Tax ID Number) or SSN (Social Security Number)
- Provider will submit claims to Bridgeview Company for the Elderly Waiver services that have been authorized using the Availity Essentials Website (or the provider’s own clearinghouse to Availity Essentials based on their trading partners agreement)
- Care Coordinator will enter a service agreement through the web based portal.
- Provider will receive Service Agreement authorization prior to rendering services that is located in PDF format on the Bridgeview Company website. The provider must render services based on the service agreement entered by the care coordinator.
- The Service Agreement letter will give the provider the member information, service agreement number, the billing service code and modifier if applicable, the total units and the maximum dollar amount that has been authorized.
- The provider must keep this letter for future reference as the information listed on the authorization will be needed when completing the claim form.
How does a Provider know if they are registered with Availity Essentials? All providers can verify if they are registered with Bridgeview Company when they log into www.Availity.com portal.
What is the process for new providers who would like to submit claims and add Bridgeview Company as a payer on Availity Essentials? A Bridgeview provider registration request form for new providers is located on the Bridgeview Company website under “Elderly Waiver Program Documents” link and selecting the Bridgeview Company Provider Registration request form. Complete the instructions on the form as indicated, if assistance is needed contact EWProviders@bluecrossmn.com
What are the billing guidelines for submitting an Elderly Waiver Claim? An Bridgeview Company Provider manual is located on the Bridgeview Company website under Elderly Waiver program documents.
How do I obtain a service agreement letter for my Secure Blue or Blue Advantage Member? After the care manager has created the service agreement authorization it will be created into a PDF format and listed on the Bridgeview Company website at https://bridgeview.bluecrossmn.com the next business day. Once on the Bridgeview home page, providers will mouse over the Bridgeview Links and select “Provider Service Agreements” and enter their their unique user ID number assigned by Blue Cross and password. The service agreements for the provider clients are listed with document search functionality.
Would an EW provider be able to bill through another clearinghouse system other than Availity Essentials (i.e. MNEConnect)? EW providers who already have their own clearinghouse can work with Availity Essentials to set up batch claims submissions. To do this, EW providers should contact Availity Essentials at support@Availity.com to let them know that they are interested in batch claim submission. Availity Essentials will work with the provider to make sure the claims the provider submits to their clearinghouse will then automatically transmit to Bridgeview Company.
How do Providers and Care Coordinators find out Blue Plus members’ ID numbers and whether or not the member is still eligible for EW services? The member ID and group number are listed on the Blue Plus member ID card and should be verified monthly. Providers can verify member eligibility through MN-ITS or EVS verification system. A member may lose eligibility for Elderly Waiver services for a variety of reasons but could still be an active Blue Plus member for Medicare or Medicaid medical services. When verifying the member in MN-ITS, there is a separate category for each category of eligibility. The section “Prepaid Health Plan” shows the members program type and the specific health plan the member is enrolled with. The section “Waivers” will state the specific waiver program they member is eligible for. There are several different waiver programs, but Bridgeview Company only processes the Elderly Waiver claims. Only members that show both Blue Plus and Elderly Waiver will have their claims processed at Bridgeview Company. It is important for providers to monitor Elderly Waiver eligibility and communicate with the Care Coordinator if they find the member is no longer eligible for Elderly Waiver under the Blue Plus health plan.
How will the member’s Elderly Waiver Obligation be applied? A waiver obligation is the amount a member is required to contribute toward the cost of EW services by member’s county financial case manager.
- Bridgeview Company receives a monthly file for members with retroactive changes and updates from DHS which is automatically updated into the claims processing system.
- Waivers will be applied to all claims submitted for the members in the order claims are received.
- All members with EW services authorizations and a waiver obligation will have the first claim that is adjudicated with a payment for that month apply the waiver amount as appropriate.
- Providers are notified of waiver obligation amounts deducted from services billed on the ERA tab. The ANSI code 178 “PATIENT HAS NOT MET THE REQUIRED SPEND DOWN AMOUNT” will appear along with the dollar amount that must be billed to the patient in the “Patient Responsibility” field on the remittance.
- Members are responsible to pay the amount of the obligation towards the services that were utilized that month to provider. This may be a portion of the billed amount or the entire service amount.
- Bridgeview Company claim examiners review monthly reporting of waiver obligation changes and updates and reprocess claims as necessary.
How does Bridgeview Company pay providers for the Elderly Waiver Services? Bridgeview Company will process and pay all Elderly Waiver claims within 30 days receipt of a clean claim. Payment to provider is by paper check or EFT (Electronic Funds Transfer), and the remittance is available to provider electronically on the Availity website. Providers can access the Direct Deposit/ ACH form under the Elderly Waiver Public documents on the Bridgeview Company website. Providers can either return the form by faxing to 218.740.4616 or to the EWproviders@bluecrossmn.com mailbox. Please allow 10 business days for processing. In the interim the provider will receive a paper check from Bridgeview Company. The Remittance Advice is still available on the Availity website.
How do I bill for Waiver Services When Client is hospitalized or at an inpatient facility? Elderly Waiver providers cannot bill for days on which the client is absent from the facility. Providers are required to bill ONLY for the actual days of service. As a policy, if a client is in the facility at midnight, the day can be counted as a day of actually services. Clients are not eligible to receive elderly waiver services during the following periods: hospital observation stays, inpatient admissions, nursing home stays, therapeutic leaves, crisis services, or days away from the home with family members or vacation. The provider must indicate the specific date ranges they provided services during the month and the associated billed amount for each date span by using the detail line items on the claim submission.
How do I submit an EW claim adjustment or corrected claim to Bridgeview Company? Replacement Claims: Providers can only send replacement claims to Bridgeview Company when the submitted claim has already been processed resulting in a non-denied claim. A replacement claim may result in a payment correction due to a revised billed amount or number or units, or it may simple change a piece of information in the claim such as a date. In the Availity Essentials website when entering a replacement claim or correction of payment, select under billing frequency 7- replacement of prior claim and entered the payer claim number that identified the claim you are requesting to replace. The claim payer number can be found on the ERA electronic remittance advice under Claim Information and Payer Claim number. If the Bridgeview Company claim number is not included on the replacement claim, it will result in a denial with ANSI 16 Remark N152 Claim/service lacks information which is needed for adjudication:
Missing/incomplete/invalid replacement claim information. Providers who submit replacement claims as their initial claim or in response to a claim denial will have those claims rejected with ANSI 125 Remark N142 Submission/billing error (s): The original claim was denied. Resubmit a new claim, not a replacement claim.
Voided Claims: Providers that submit claims to Bridgeview Company in error must use this process in order for Bridgeview Company to recoup monies paid out to provider. When a voided claim is submitted, it must be an exact match to the claim information that was originally submitted. If the information does not match to the claim information is not submitted as a void, it will be rejected as a duplicate claim. A voided claim can be submitted in the Availity Essentials website under claims submission and selecting under billing frequency #8 voided claim in addition, including the payer claim number that you wish to void. This claim number can be found on providers’ electronic remittance advice under Claim Information and Payer Claim number. Once the voided claim is received by Bridgeview Company the claims examiner will void the claim as requested. The payment recovery amount will be subtracted from the provider remittance and will display on the ERA page with a claim status 22 Reversal of Previous Payment. There will also be negative amounts in the submitted charge section when the claim recovery is processed. The claim as the void will then be denied with ANSI 129 Remark MA67 Submission/billing error (s): Correction to a prior claim. (Revised June 2011)
How can EW Providers get their billing questions answered?
- EW Providers can contact Bridgeview Company directly regarding claim questions at Ewproviders@bluecrossmn.com or by calling 800-584-9488 or 218-740-2336.
For Additional Services Regarding Waiver Services
- More specific billing guidelines refer to the Bridgeview Provider Manual located Bridgeview Links/Elderly Waiver Program documents.
- If you need additional information regarding waiver services, please log on to the DHS web site under the provider manual by going to: