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Submitting Claims

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Please note: These Frequently Asked Questions include general information only. For more specific information, please call Provider Service at (800) 832-6011 (822-8181 from Greater Portland).  
 
What are the HCFA 1500 claims submission guidelines for Anthem BCBS in Maine?
The claims submission guidelines are outlined in this handy reference.  
 
 
Where do I submit my claims?
Click here for our convenient department reference grid, including billing addresses.  
Please continue to contact us locally at (800) 832-6011 (822-8181 from Greater Portland) for your benefit and claims questions.  
For faster claims processing, enroll in our electronic submission program. If you are not set up to submit claims electronically and would like to receive a list of approved vendors or a product demonstration, please call our EDI Client Services Team at (207) 822-8385 to discuss system requirements and options.  
 
 
I have submitted a claim to Medicare. Do I need to resubmit this claim to Anthem BCBS?
No-Medicare claims are automatically submitted electronically to us, excepting claims for railroad retirees. You do not need to submit Medicare claims on paper to us, and submitting the claim from your office could delay processing, while we research the duplicate claim. If you receive acknowledgement from Medicare that the information has been forwarded to Anthem Blue Cross and Blue Shield in Maine, that means your claim has been submitted electronically to us. The code "MA18" indicates that the claim has crossed over from Medicare. When you include the member's Anthem BCBS certificate number in the Medicare submission, Medicare will include that number in its electronic submission. If you have not received your remittance advice within 4 weeks of the date of the acknowledgement, please call Provider Service at (800) 832-6011 (822-8181 from Greater Portland).  
 
 
Do I need to submit a paper claim to Anthem BCBS for Medicare supplemental claims?
Under ordinary circumstances, no-the claim will be sent electronically by Medicare. If 4 weeks have passed without a response from us and, when you contact us, we ask you to submit your claim, please do so as follows:  
For Part A services (institutional), please submit a UB-92 form along with the Part A Medicare remittance advice.
For Part B services (professional)
If the certificate prefix is not XVB and Medicare is primary, please submit the Part B Medicare remittance advice and a HCFA 1500 form. (File in the same manner that you file a non-Medicare claim, but attach the Medicare remittance advice.)
If the certificate prefix is XVB, the member has Medigap or Group Companion Plan coverage. Please submit only the Part B Medicare remittance advice, adding the member's Anthem BCBS certificate number.
 
In compliance with HIPAA requirements, we must receive only the pertinent protected health information (PHI) for each claim. If you have a sheet of Medicare remittance advice containing multiple patients' information, please black out all but the appropriate entry, circle the appropriate entry, and write the member's certificate number next to it. Please do not use a highlighter on the remittance advice. Scanning equipment cannot "read" highlighted information.  
 
 
I am submitting a number of paper Medicare claims together. How should I prepare the packet?
Most Medicare claims are sent to us electronically from Medicare, so you may not need to do anything at all. However, if you find you need to submit some claims, please submit as follows:  
Please staple each individual claim form to its own pertinent Medicare remittance advice. In compliance with HIPAA requirements, please attach only the pertinent protected health information (PHI) with each claim. If you have a sheet of EOMBs containing multiple patients' information, please black out all but the appropriate entry, circle the appropriate entry, and write the member's certificate number next to it. We will need a separate remittance advice sheet for each patient. Please do not use a highlighter on the remittance advice. Scanning equipment cannot "read" highlighted information.  
 
 
How do I submit a claim when Anthem BCBS is the secondary insurer?
Most Medicare claims are sent to us electronically by Medicare, so you may not need to do anything at all. Click here for what you need to do for Medicare. For other insurers, please send the EOB or remittance advice from the primary insurance carrier with the member's certificate number on all pages.  
For institutional services, please submit a UB-92 form along with the EOB or remittance advice.
For professional services, please submit a HCFA-1500 form along with the EOB or remittance advice.
Please black out all other patients on the EOB or remittance advice and write the member's certificate number next to the pertinent EOB or remittance advice. This is in compliance with HIPAA requirements. Please do not use a highlighter on the remittance advice. Scanning equipment cannot "read" highlighted information. Also, please include your Anthem BCBS 6-digit provider ID number on all submitted pages.  
 
 
I am resubmitting a number of claims with additional information. How should I prepare the packet?
For reconsideration of a claim that has been denied, please include a single cover sheet for the packet labeled "additional information." Include the member's certificate number on each additional sheet, along with your Anthem BCBS 6-digit provider ID number. Send only the remittance advice along with the additional information. Do not include the original claim. Click here for our convenient information table, including billing addresses.  
 
 
I know I need to put my Anthem BCBS ID number on the claims in Box 33 by the PIN #, but what does my Anthem BCBS ID number look like?
Your Anthem BCBS Provider ID number is a 6-digit number that contains no alpha characters. If you don't know your 6-digit provider ID number, please contact Provider Services at (800) 832-6011(822-8181 from Greater Portland). Please note: Your Anthem BCBS ID number is not your Medicare number or your Tax ID number.  
 
 
How do I send in a refund for overpayment?
Our website has a number of commonly used forms ready to download for your convenience. Please click here to go to the forms page, then select the Refund Transmittal/Credit Remittance Advice. Once you have printed the form, please follow the directions included on the form.  
 
 
How do I check claim status with Online Provider Services?
Online Provider Services gives you free, 24/ 7 access to membership eligibility and claims status information. To enroll in this convenient service, please take a few moments to register. Once you have enrolled and have received your password, you can check anytime from anywhere by logging on and following the screen prompts. Please note: if you are a professional provider looking for Medigap/Group Companion claim information (certificates with XVB prefix), these claims cannot be viewed online at this time. Please call Provider Service at (800) 832-6011 (822-8181 from Greater Portland) for information on these claims.  
 
 
What is the best way to help make sure my claim is processed under the correct member?
Please be sure to see the patient's insurance ID card each time you see the patient. File the claim with the number exactly the way it appears on the ID card, and be sure to use the correct patient name. The ID number should be a 3-digit alpha prefix followed by a 10-digit number. All family members under the same subscriber will have the same ID number. We check the individual's membership with each submitted claim.  
 
 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use