Oklahoma City Clearinghouse
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SB580, SB690 - CareFirst BCBS MD, CareFirst BCBS DC - Claims - Transactions - Rejection
Incident
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Identified
CareFirst BCBS requires that Sequestration Adjustment be included on Professional Medicare Crossover Claims.
CareFirst BCBS will reject Professional Medicare Crossover Claims when there is a Medicare Payment indicated with no related CAS (Claim Level Adjustment) information included.
In addition, CareFirst requires this adjustment to appear at the line level of every claim where the Medicare payment is more the .50. Medicare reports the payment reduction as a CAS*CO*253.
There must be an instance of either CAS02, CAS05, CAS08, CAS11, CAS14, or CAS17 that equals(=) 253 when Loop 2320, segment SBR01 = P and SBR09 = MB; Loop 2430 SVD02 is greater than .50 and CAS01 =PR.
Please include Sequestration Adjustment to avoid any claim rejections from the Payer.
REF 670152
CareFirst BCBS will reject Professional Medicare Crossover Claims when there is a Medicare Payment indicated with no related CAS (Claim Level Adjustment) information included.
In addition, CareFirst requires this adjustment to appear at the line level of every claim where the Medicare payment is more the .50. Medicare reports the payment reduction as a CAS*CO*253.
There must be an instance of either CAS02, CAS05, CAS08, CAS11, CAS14, or CAS17 that equals(=) 253 when Loop 2320, segment SBR01 = P and SBR09 = MB; Loop 2430 SVD02 is greater than .50 and CAS01 =PR.
Please include Sequestration Adjustment to avoid any claim rejections from the Payer.
REF 670152
This incident affects: Professional and Batch.