How to enoll and advantage of EFT

Advantages of Electronic Funds Transfer (EFT)

EFT is similar to other direct deposit operations such as paycheck deposits, and it offers a safe modern alternative to paper checks. Providers who use EFT may notice the following benefits: 

* Reduction to the amount of paper in the office Valuable time savings for staff and avoidance of hassle associated with going to the bank to deposit Medicare checks 
* Elimination of the risk of Medicare paper checks being lost or stolen in the mail 
* Faster access to funds; many banks credit direct deposits faster than paper checks. 

How to Enroll in EFT 

All Medicare contractors include an EFT authorization form in the Medicare enrollment package. Complete the form and mail it to the Medicare contractor. Be sure to include a voided blank check so account information may be verified. If eligible, Medicare payments will be made directly to the financial institution through EFT, in as little as two weeks.

Note : Contact the Medicare contractor for additional qualifications and terms. If for some reason the form is not received with the enrollment package, simply contact the Medicare contractor and re- quest a form.

CLAIMS PAYMENT Guideline bcbstx

Upon receiving claims, BCBSTX analyzes them for covered services. BCBSTX generates a Remittance Advice (RA), summarizing services rendered and payer action taken, and sends the appropriate payment amount to the Provider. If no payment is warranted to the Provider, a Claims Disposition Notice (CDN) is sent to the Provider with the specific claims processing information.

BCBSTX shall adjudicate (finalize as paid or denied) a clean claim within 30 days from the date the claim is received. BCBSTX will pay Providers interest at a rate 18 percent per annum, calculated daily on clean claims that are not adjudicated within 30 days.

BCBSTX shall adjudicate (finalize as paid or denied) a clean claim for electronic pharmacy submissions within 18 days after adjudication, and not electronically submitted no later than 21 days after adjudication. BCBSTX will pay Pharmacy Providers interest at a rate of 18 percent per annum, calculated daily on clean claims for pharmacy claims that are not adjudicated within 18 days.

Unless otherwise noted below, Physicians and other Professional Providers will receive payment and remittance advices (RAs) in a paper format.

Electronic Fund Transfer

BCBSTX allows the electronic fund transfer (EFT) option for claims payment transactions. This allows claims payments to be deposited directly into a previously selected bank account. You can enroll by calling EDI Services at 800-746-4614.

Electronic Remittance Advices

Providers contracted with BCBSTX can choose to receive electronic remittance advices (ERAs). ERAs are received through the SPC: MAILBOX. The SPC: MAILBOX is a mailbox set up between a provider or clearinghouse and BCBSTX. Use the mailbox to send and receive ERA files, which are in an ASC X 12N 835 file format. There is no charge for the service, but enrollment is required. Providers can enroll by calling EDI Services at 800-746-4614.

Electronic data transfers and claims are HIPAA-compliant and meet federal requirements for EDI transactions, code sets, member confidentiality, and privacy. To enroll for Electronic Remittance Advices, go to www.bcbstx.com/provider/claims/era.html.

Online Remittance Advices

Providers can also obtain a copy of their remittance advices online through their selected clearinghouse. Please note that your remittance advices may be in summary format. For example, if you are reviewing an inpatient claim paid at a Diagnosis Related Group (DRG) rate, your remittance advice is generated as a summary, as opposed to full line detail.

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