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In November 2013, Independence began transitioning its members to a new
claims processing platform. The new
platform offers greater capabilities, increased flexibility in benefit design,
and enhanced functionalities to improve the
overall customer experience.
We have made significant progress on this important transition, including
the following milestones:
- Transition of X12 transactions. As of November 1, 2013, all trading
partners send and receive transactions to/from the Highmark Gateway.
- FEP and Host claims. Claims processing for Federal Employee Program
(FEP) and Host BlueCard® was migrated to the new platform on
November 1, 2013.
- Commercial member claims. Since November 2013, we have been
migrating our commercial members to the new platform, generally based on when
the customer/member's contract renews. As of October 1, 2014, approximately
half of our existing commercial members have been migrated to the new
platform.
Independence will migrate all Medicare Advantage HMO and PPO members to
the new platform on January 1, 2015.
We anticipate that all members will be migrated to the new platform by
March 2015.
Dual claims-processing environment
During the migration, we are working with you in a dual claims-processing
environment until all of our business is
on the new platform. In other words, we are processing a larger portion of
claims and business transactions on the
new platform as members are migrated, and we continue to process claims and
conduct business transactions on
the current platform for members who have not yet been migrated.* The date of
service will determine the platform
on which these claims will be processed.
Check member ID cards at every visit
As members are migrated to the new platform, they are issued a new member ID
card. For this reason, it is
imperative that provider offices do the following:
- 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.
- Verify eligibility and benefits using the NaviNet® web
portal prior to rendering service.
Independence will assign migrated members a new 12-digit member ID number,
called a "unique member ID" (UMI).
Each member ID card will include the member's name and the subscriber's UMI.
The subscriber and all members
covered under the subscriber's policy will share the same ID number. Some plans
will also be assigned a new
three-character alpha prefix, which will also appear as part of the ID
number.
Note: Members with MedigapSecurity (a Medicare Supplement plan) will
be assigned a 13-digit ID number, with
the last digit being an alpha character.
Resources
We will continue to work closely with you and our entire provider network as
we complete our Business
Transformation. For more information, visit our dedicated
Business Transformation
site.
On this site you will find a communication archive as well as frequently asked
questions. If you still have
questions after reviewing these resources, email us.
*Behavioral health claims for HMO/POS non-migrated
members should continue to be submitted to Magellan Behavioral Health, Inc.
Behavioral health claims for all migrated members, including HMO/POS, should be
submitted to Independence.
Magellan Behavioral Health, Inc., an independent company, manages mental health
and substance abuse benefits for most
Independence members.
NaviNet® is a registered
trademark of NaviNet, Inc., an independent company.