Billing and Payment. Chapter

Transcription

1 Chapter 3 Billing and Payment Capital BlueCross billing process is simple. For our insured customers, we create a bill each month that is based on the information in our files as of the date the bill was produced. We send you the statement and you forward the amount due to us. For groups with 99 enrolled Subscribers or less, payment is due on or before the first or the fifteenth of the month (depending on your billing cycle). The statement indicates the payment due date. Large groups (with 100 or more enrolled Subscribers) may have weekly or monthly billing periods based on the financial arrangement they have selected. Payment due dates for large groups are also clearly defined with the possibility of claim denial and group cancellation if payment is not received when due. For billing questions, contact Group Services at It is important that we receive your payment on or before the date it is due. Please pay the amount that is listed on the statement. As explained below, do not change the amount billed to your group. For our non-hmo products, if payment is late, your Members claims will be suspended from payment processing. If the full amount due and owing is not received by the end of your grace period, benefits will be denied, claims will be rejected, and your coverage may be canceled under the terms of your contract. For HMO products, we expect payment by the due date as well; however, state legislation requires continued claims payment through the grace period until such time as the group s coverage is terminated, and the group remains responsible for the payment of any applicable premium during this time. If your group also offers one of our Medicare Advantage plans (SeniorBlue HMO, SeniorBlue PPO), you will receive a separate billing. Medicare Advantage questions may be directed to

2 3.2 Group Administrator s Manual Any group customer may contact our Account Administration Department at with billing questions. Please note that words that are double underlined are defined in the Reference and Glossary chapter. Shaded portions in Chapters 1 through 8 apply only to large group customers such as Experience-Rated Groups and Administrative Services Only (ASO)/Self-Funded Groups that have 100 or more enrolled Subscribers. rkd/a2/8400/2.doc (10/2012)

3 Group Administrator s Manual 3.3 The PlusBilling System Our simplest billing system is called PlusBilling. Here s how PlusBilling works: We calculate your monthly bill and mail a statement to you approximately 15 days before payment is due. (HMO group statements are mailed approximately 25 days before payment is due.) You receive a bill for each grouping of individuals you chose at the time of group enrollment (e.g., you may have one bill for Harrisburg employees and one for Allentown employees). We call each of these categories of enrollees subgroups and each subgroup has its own subgroup identification number. Group employees can be divided further into classes. Examples of classes are hourly employees and salaried employees or full-time and part-time employees. Your group may choose to have your monthly bill sorted by class and alphabetically within the class or by class, by product within the class, and alphabetically within the product. Just notify your Account Executive of your preference. Your total premium due is shown on your PlusBilling statement. The statement includes your return payment portion (to be returned to us with your payment). If a full employee listing is included with your PlusBilling statement, it shows all Subscribers enrolled in your group for the billing period. Changes for the billing period, such as added dependents, are also shown, but only if a rate change occurs or the family indicator changes. (See page No. 10 for a detailed explanation of family indicator. ) Each month you will see enrollment adjustments (which appear as Retroactive Adjustments ) on your statement. This allows you to quickly check your offcycle enrollment information with what we ve processed for you. rkd/a2/8400/3.doc (10/2012)

4 3.4 Group Administrator s Manual Specific Billing Practices Newborn or Adopted Dependents Always report the addition of a newborn or adopted child, even if there is no rate change in billing (e.g., if the contract is already a family contract with children). If the contract is not for family coverage until the birth of the newborn, payment for family coverage is necessary retroactive to the billing period for the month in which the child was born, provided enrollment was submitted within 60 days of the birth. If the dependent child is born or adopted in the time period from the first through the fifteenth of the month, your group is billed for the rate change (if applicable) for the entire month in which the child is born/adopted. If the dependent child is born or adopted in the time period from the sixteenth through the last day of the month, your group is billed for the rate change (if applicable) as of the first of the following month in which the child is born/adopted. Death of a Member In the event of a death, termination of a contract (or removal of a spouse/dependent) becomes effective the first billing date for your group after the date of death. There are certain exceptions. For example, if your group reports a deceased Subscriber who has active dependents remaining on the contract, the retroactive period is limited to 60 days. rkd/a2/8400/4.doc (10/2012)

5 Group Administrator s Manual 3.5 PlusBilling for Groups PlusBilling Member Statement The PlusBilling Member Statement contains a summary page listing the billing essentials and subsequent pages contain subdivisions listing two categories Current Employee Enrollments and Retroactive Employee Adjustments. With this type of billing you receive a complete list of activity within the billing period as well as a complete listing of Members enrolled in your group coverage each month. The final page of the statement also contains a Class Totals box listing every class in the subgroup and the total amount due for each class. Examples of all billing forms are found in the Forms and Reports chapter. Instead of receiving a statement via regular mail, certain groups may elect to receive Electronic Member Statements via secure . These statements are invoices in Excel format. Along with these statements, groups receive either a supplemental hardcopy PlusBilling Member Statement or an Electronic Invoice Summary (an at a glance explanation of the group s Electronic Member Statement and a paystub for the group to return along with premium payment). If you are interested in this type of billing, notify your Account Executive. rkd/a2/8400/5.doc (10/2012)

6 3.6 Group Administrator s Manual Billing for Large Groups Large groups with insured financial arrangements receive a PlusBilling Member Statement. Insured groups pay monthly rates and receive monthly statements. Examples of all billing forms are found in the Forms and Reports chapter. Self-Funded Arrangements Some Self-Funded groups pay an administrative fee each month for each enrolled Subscriber or Member, depending on their financial arrangements. Also, the group pays for the claims paid by Capital BlueCross for the arrangement s specified billing period. Self-Funded groups are invoiced differently from the groups who pay a monthly rate. As long as the groups are HIPAA compliant (see Chapter 7, HIPAA Privacy and You ), we also send these groups a list of claims we have paid on the groups behalf. rkd/a2/8400/6.doc (10/2012)

7 Group Administrator s Manual 3.7 The PlusBilling Form The PlusBilling Form is a two-part carbonless form we provide to help you report and track your group changes. Use this form to send us your enrollment additions, changes, and terminations along with the application change forms completed by your employees. You should also routinely compare this form to your billing statement to ensure all requested changes have been processed. Checking Your PlusBilling Statement You will want to make sure your monthly bill is correct before sending us your payment. Key things to check include: Payment Due Date. Total Premium Due (including amounts we adjusted since the last billing period and any past due premium). Employee Listing (especially additions, terminations, adjustments). Your copies of the PlusBilling Forms. Compare them against your monthly statement to make sure we ve made all the changes/updates you ve requested. After checking your PlusBilling statement, you will either agree with the information listed, or you may find that your records differ from ours concerning who should be enrolled. If your records MATCH our records and you agree with the information on your PlusBilling statement, generate your payment (epayment or check). If paying by check include the tear-off portion of the statement, write your group ID (including subgroup) and invoice number on the check, and send us the payment in the envelope provided so we receive it on or before the due date. Including the tear-off portion of your invoice helps us apply your payment correctly within our system and prevents administrative errors and oversights. (If you have more than one subgroup, we must have appropriate payment for each. Please label checks with group and subgroup information to expedite payment information.) rkd/a2/8400/7.doc (10/2012)

8 3.8 Group Administrator s Manual If your records DO NOT MATCH our records, generate your payment for the premium shown on your statement. Even if your current Member listing is different than what is shown on your bill, you must pay as billed in order to assure that your claims continue to be processed normally. Please DO NOT write enrollment changes on your invoice. Submit enrollment changes on the proper forms so that they are processed properly. See Adjustments to Your Bill for further details. Methods of Payment With today s busy lifestyle, Capital BlueCross recognizes the need to keep things simple. With that in mind, we encourage our customers to consider electronic payment options for their health insurance premiums. Bill Payer Capital BlueCross is a participant of a Remittance Payment Processing System (RPPS) network. As the Group Administrator, you have the opportunity to initiate an electronic payment through your financial institution to make your health premium payment any time it s convenient for you. By selecting Capital BlueCross as your vendor and entering your 12-digit group ID in the account field, your payment electronically updates your invoice statement. Check with your current bank institution if you are not already enrolled in a Bill Payer system. Check It Out Is an automated payment option that will deduct your premium directly from your bank account. This free option saves you time and money as there are no checks needed, no stamps used, and no worries about mailing payments on time. You can choose to complete the enrollment form and submit it online. Or, you can complete the enrollment form, attaching a voided check for account confirmation, and return it to us via U.S. mail. You will receive peace of mind knowing that your health insurance premium will be paid on time with no additional effort by you. Visit to complete an enrollment form. rkd/a2/8400/8.doc (10/2012)

9 Group Administrator s Manual 3.9 Wire payment Is an electronic option which provides you with control over transfer of premium due. You decide the right time to make the payment and initiate this payment with your financial institution. Your bank will inform you of fees for this option. By check You can generate a check for the amount due shown on your statement, include your copy of the return payment portion of your statement, and send to us in the return envelope provided with your invoice. Be sure to write your group ID and the invoice number on your check, and send us the payment so we receive it on or before the due date. Adjustments to Your Bill Use your PlusBilling Form and/or enrollment application to send us information to adjust NEXT MONTH S bill to make corrections you feel are appropriate. You may mail the PlusBilling Form to us at the address provided on the form, fax us the form at , or feel free to call Group Services at , with the change. Please make sure to send us the change as well. Be sure to always include: The Subscriber ID (Identification Number). The Subscriber s Name (and the name of the dependents, if changes are needed). Group/Subgroup ID (Group Number) and Group Name. Effective Date for the correction. Details of the corrections (e.g., terminate or remove dependent, etc.). Your Name and Telephone Number. rkd/a2/8400/9.doc (10/2012)

10 3.10 Group Administrator s Manual Nonpayment Notification It is important for every group to make timely payment of its invoice. Moreover, Capital BlueCross typically notifies group customers of nonpayment in writing when we do not timely receive the amount due for coverage. When the notification process begins, groups are classified as delinquent. To the extent permitted by law and under your contract with Capital BlueCross, when payment is not made in a timely fashion, claims processing may be suspended for the group and its Members as of the payment due date. Once a group is classified as delinquent, Providers and Members may not be able to obtain benefit verification in most circumstances. Unless otherwise required by law, claims processing and benefit verification will only begin again when payment is made for the amount past due. For all group customers, if payment is not received by the date specified in the nonpayment notice, the group will be canceled according to the terms in the Group Contract. HSA/HRA Billing Fees for the administration of HSA/HRA accounts are billed and collected by separate vendors. Groups must contract directly with a banking partner for HSA services. rkd/a2/8400/10.doc (10/2012)