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Business Transformation has been completed

April 1, 2015

Independence is pleased to announce that the transition of our membership and claims processing to a new operating platform has been completed. As you know, Independence began this transition in November 2013. The new platform offers greater capabilities, increased flexibility in benefit design, and enhanced functionalities to improve the overall customer experience.

This important transition included the following milestones:

  • Transition of X12 transactions. All trading partners send and receive transactions to/from the Highmark Gateway as of November 1, 2013.
  • FEP claims. Institutional claims processing for Federal Employee Program (FEP) members were migrated to the new platform on November 1, 2013. Professional claims processing for FEP members should continue to be submitted with Highmark as the payer.
  • Host claims. Claims processing for professional Host Medicare Advantage PPO (MA PPO) BlueCard® claims and institutional Host claims was migrated to the new platform on November 1, 2013.
  • Medicare Advantage HMO and PPO member claims. All Medicare Advantage HMO and PPO members were migrated to the new platform on January 1, 2015.
  • Commercial member claims. All commercial members have now been migrated to the new platform. This transition of commercial member claims happened over time, generally based on when the customer/member?s contract renewed.

Important changes as a result of the transition

Below are some of the important changes that occurred as a result of our transition to the new platform. These changes affect the way you do business with Independence.

  • Member ID cards/numbers. As members were migrated to the new platform, they were issued a new member ID card with a new ID number and, in some cases, a new alpha prefix. The subscriber and all members covered under the subscriber?s policy share the same ID number.
  • Provider payment. Now that all members are migrated, you will receive a different format of the Statement of Remittance (SOR) ? called the Provider Explanation of Benefits (professional) and Provider Remittance (facility). On the new format for facility claims, services have been combined and displayed on one line. Note: You will continue to receive an SOR for dates of service that occurred prior to the member?s migration to the new platform. In addition, 835 transactions generated on the new platform contain additional and updated information. Please refer to our Trading Partner Business Center for more specific information.
  • Claims processing. Additional data elements are required to ensure proper claims processing on the new platform. For example, taxonomy codes are required on all claims submissions. Information regarding the specific data elements required can be found in the Independence Blue Cross HIPAA Transaction Standard Companion Guide, which is available on our EDI website.
  • Provider Automated System. Now that all members have been migrated to the new platform, the Provider Automated System is no longer available for any functionality (e.g., eligibility, claims status, authorizations). Providers must use the NaviNet® web portal to retrieve this information.
  • NaviNet. Many changes have been implemented on Independence NaviNet Plan Central, including adding, removing, and enhancing transactions. For more specific information, please refer to the NaviNet Transaction Changes section of our Business Transformation site. This section of our site contains user guides and webinars for the new or enhanced transactions.

Check member ID cards at every visit

Because all members were issued a new member ID card upon migration, it is imperative that provider offices do the following:

  1. Obtain a copy of the member?s current ID card at every visit to ensure that you submit the most up-to-date information to Independence.
  2. Verify eligibility and benefits using NaviNet prior to rendering service.

For more information

For more information, visit our Business Transformation site. This site contains a communication archive as well as a frequently asked questions (FAQ) document. If you still have questions after reviewing the FAQ, email us.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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