What's new

Claims processing for Regence BCBS FEP has resumed

Regence Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP®) claims processing has fully resumed after a systems issue temporarily impacted professional, facility and dental BCBS FEP claims in our four-state service area.

  • Claims received between February 23 and March 7, 2024, from in-network providers were processed as non-participating and/or denied incorrectly. These claims are automatically being reprocessed and providers will receive updated claims status on future remittance advices within 30-45 days. No action is required from providers.
  • Claims submitted during the suspension period are being processed as normal in the order they were received. Claims processing is fully functional and providers can continue to submit claims.

If you have questions, please contact our BCBS FEP Provider Contact Center.

3/18/2024

Support for providers using Change Healthcare as their EDI clearinghouse

As Change Healthcare (CHC) systems remain disconnected in the wake of a cyber security incident, we are aware that some providers and hospitals that use CHC are unable to send claims electronically to insurance companies, including Regence.

  • CHC has announced a temporary funding assistance program to help providers with short-term cash flow needs.
  • We encourage providers to use Availity as an alternative clearinghouse for electronic claims submissions. Availity has prioritized new provider registrations to assist health care organizations affected by this incident. By signing up through Availity’s fast-track process, Lifeline, claims submissions can begin quickly. For those who cannot self-serve, please contact Availity through it's Lifeline support page.
  • There is no impact to our pre-authorization process currently. Providers experiencing challenges brought on by the CHC outage have the option to use our e-auth system on Availity or our longstanding practice of accepting faxed requests.

We’ll continue to monitor and assess the situation and will provide updates as they become available.

3/6/2024

Change Healthcare service interruption

Change Healthcare is experiencing a network interruption related to a cyber security incident and has disconnected its systems while it determines the scope of the incident. This interruption has led to various processing delays.

We are in contact with Change Healthcare and are working to determine how this incident may affect our providers and members. We will provide updates as information is available.

Availity has posted directions for providers who have an existing account. For details on submitting transactions during the Change Healthcare outage, sign in to Availity Essentials and click on the pop-up message for instructions.

Change Healthcare, a subsidiary of Optum, is working to restore affected systems. Optum is providing status updates on an incident tracking page.

2/23/2024

Annual HEDIS medical record collection begins

Our Healthcare Effectiveness Data and Information Set (HEDIS®) medical record reviews for measurement year 2023 will begin this month, continuing through May 2024. We have contracted with ComplexCare Solutions (formerly Inovalon) to contact providers and collect data using a HIPAA‑compliant process. We appreciate your help during this process and will work with your office to collect medical records by fax, mail or onsite visit (for larger clinics).

As a reminder, it is your responsibility as a participating provider to respond to these requests in a timely manner. Unless your provider agreement specifically states otherwise, you are required to provide us or ComplexCare Solutions access to member records for these purposes free of charge. A signed release from your patient—our member—is not required for us to obtain these records. If you contract with a copy service, please remember that you are responsible for guaranteeing they deliver the charts on time, without cost, to us or ComplexCare Solutions.

You can learn more about this year’s review on our website: Programs>Quality>Quality Program>HEDIS Reporting.

2/13/2024

In-home and virtual health assessments for Medicare Advantage members

We have partnered with a team of providers who conduct comprehensive in-home and virtual health assessments to accurately assess and document a member’s current health status. During the assessment, the provider also observes and documents social determinants of health (SDoH). Our currently contracted vendors for these assessments are Signify Health and Advantmed.

Signify Health and Advantmed will begin outreach to Medicare Advantage patients in February 2024. Learn more about our Risk Adjustment program, including health assessments for Medicare Advantage members.

2/13/2024

Subscribe to receive our newsletters and bulletins

Our newsletter and bulletin contain important information and notices of changes that impact your office, including recent and upcoming changes to policies and pre-authorization requirements.

Subscribe to make sure you don't miss important news and policy updates.