Change to Some Primary and Secondary Claims Coordination
Beginning Dec 13, 2021, when a Blue Cross and Blue Shield of Texas (BCBSTX) member has primary and secondary health insurance coverage from either two BCBSTX plans or a BCBSTX and one of the four plans listed below, we will be making changes to increase efficiencies in coordinating payment which will help reduce the time it takes to process these claims.
- Blue Cross and Blue Shield of Illinois
- Blue Cross and Blue Shield of Oklahoma
- Blue Cross and Blue Shield of Montana
- Blue Cross and Blue Shield of New Mexico
What’s changing for providers
In the new process, for claims that meet the above criteria, you will:
- First submit just the primary claim;
- Second receive the determination on the primary claim through your normal channels detailing the primary claim adjudication, then
- Third submit the secondary claim providing the primary claim payment information under the secondary policy following the guidelines documented in the PPO and HMO Provider Manuals section on Filing Claims-Prompt Pay.
Note: The following standard guideline for timely filing with Coordination of Benefits has not changed.
- Primary claim timely filing begins at date of services rendered.
- Secondary claim timely filing begins at date of primary claim final adjudication.
If you have any questions, please contact your local BCBSTX Provider Network Representative.