BCBST Electronic Eligibility Processing
BlueCross BlueShield of Tennessee (BCBST) accepts electronic eligibility files in the HIPAA 834 layout with BCBST specifications or in some situations the BCBST proprietary layout. Additionally, the HIPAA 834 layout without BCBST specifications will be accepted provided that enough information is included to meet minimum system requirements of our claims processing system.
BCBST accepts full or changes only files. The process compares the client data to the data on our system, and the resulting differences are either loaded electronically or sent to paper for manual keying. Eligibility that appears on the error/warning reports are either reported back to the group for correction on the next data file or manually keyed within seven days of the file process date.
The average number of days for the process to be implemented is 45 days for clients who send either the HIPAA 834 with BCBST specifications or the BCBST proprietary layout. The average number of days for the process to be implemented is 150 days for clients who send the HIPAA 834 with out the BCBST specifications. This time estimate includes initial setup, testing for initial load into our system, and testing for on-going updates. The additional days required for processing the HIPAA 834 without BCBST specifications includes developing an interface program to handle the client's specifications and mapping to meet our system requirements.
The expectation is that the account data received by BlueCross BlueShield of Tennessee is 98 percent accurate. The process will be implemented once the 98 percent accuracy rate is met. Additionally, the process will be reviewed periodically to ensure that the process is working as expected.
The frequency of the file transmitted to BCBST will be determined on the volume of changes expected. BCBST accepts files on weekly, bi-weekly, and monthly basis. Files are electronically processed within three working days of receipt. In general, files received prior to 3:30 p.m. eastern standard time should be processed on the day the file is received. Files received after 3:30 p.m. should be processed the following day. If the file does not meet the minimum HIPAA or BCBST requirements, it will be rejected. Notification of the file rejection will be provided to the client within 24 to 36 hours of the processing time.
The media used to transmit the file to BCBST will be discussed during the initial setup. Some of the media options include, Virtual Private Network, SEFT (upload via BCBST web site), SecureFTP.