Wiki Payer ID 54704

[avacollins]

Please is anyone else experiencing this issue???

As of last week none of our claims have been able to go through to this payer ID for Independence Blue Cross. IBX is in the process of transitioning to a new platform, Smart Data Solutions, and has specifically advised providers NOT to change the "headers" in the EDI files when submitting claims. We have not changed anything in our submission process which is done via a billing vendor who uses the Availity clearinghouse. Somewhere in this process the claims are not being routed to the correct payer ID, 54704, and are instead going out with a header of ISA08. So every single claim is being rejected as being sent to the wrong payer. IBX has no answers to this problem, Smart Data Solutions has no answers, our billing vendor has no answers, and Availity is nearly impossible to deal with. There are no updates on any sites acknowledging this issue, although I was informed by our billing vendor that there are several other providers experiencing the same problem with this specific payer ID.

If you have any answers to what is going on here please let me know!

 

[Louke]

Hello, Check out this article from IBX eff 1/1/2024 hope this helps:
https://provcomm.ibx.com/pnc-ibc/news/Pages/Requirements-for-billing-with-taxonomy-codes.aspx
Claims & Billing Requirements for billing with taxonomy codes December 13, 2023

Submitting Claims

Effective January 1

As we prepare to move to our next generation platform in January 2024, we want to advise you of some additional requirements related to the use of taxonomy codes.
Providers should work with their third-party billing agency and/or clearinghouse to ensure compliance with these requirements.
As of January 1, 2024, we require the use of taxonomy codes to ensure proper claims processing and payment. This allows for the accurate application of specialty-driven policies and matching of the provider's agreement(s) with Independence Blue Cross.
Failure to submit claims with the applicable NPI and correct correlating taxonomy code will result in claim denials that must be corrected prior to payment consideration.
Professional claims
When billing professional claims, the appropriate taxonomy code must be entered in the segments indicated below. Do not leave blank.
Electronic claims (837P)

• Loop 2000A/Segment PRV = Billing Provider taxonomy code
• Loop 2310B/Segment PRV = Rendering Provider taxonomy code
• Loop 2420A/Segment PRV = Rendering Provider taxonomy code (when different from what is reported at the claim level)