Name of Manual - Blue Cross and Blue Shield of Minnesota

Reimbursement / Reconciliation
Reimbursement
Payment Methodology Please refer to your provider contract for professional provider
payment methodology details.
Direct Payment Because you are a participating provider, we send claims payments
directly to you. Payments are sent weekly.
Effective December 15, 2009, Minnesota Statute 62J.536 requires
all health care providers to accept from group purchasers the health
care payment and remittance advice transaction (835). The statute
further allows the use of web-based technology for complying with
the requirements as long as the data content and rules of the
Minnesota Uniform Companion Guides are followed.
Electronic Funds
Transfer
Beginning second quarter 2011, Blue Cross and Blue Cross Blue
Shield of Minnesota and Blue Plus (Blue Cross) will no longer
print and mail any paper remittances. Providers will also not be
able to obtain a printed copy of the remittance through provider
services except for remittances produced before February 2010.
Providers must register through Availity to receive the electronic
835 or register for access to our provider portal, provider web selfservice
(PWSS) to view their remittance information. Providers
can register for both options. The full on-line view through the
portal via PWSS was available as of September 22, 2010.
A nonparticipating provider generally receives neither direct
reimbursement from Blue Cross nor a copy of the statement for
any member who has Blue Cross coverage. Members cannot
assign benefits to providers. We pay the member directly for
nonparticipating Minnesota or border providers. However, the
provider will be paid directly if the member has
PMAP/MinnesotaCare coverage.
Blue Cross and Blue Shield of Minnesota and Blue Plus offer
Electronic Funds Transfer (EFT). Instead of weekly checks with
your remits, you can now receive electronic payments directly into
your facility’s checking or savings account. The funds are securely
transferred via the Automated Clearinghouse (ACH) process.
Electronic payment will streamline your reconciliation process,
eliminate deposit delays due to check handling, and improve cash
flow.
To access a copy of the Provider Automatic Payment application,
please visit our website; click on the Provider icon and then forms.
9-2 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (11/02/11)