Blue Cross NC Medicare Advantage and Medicare Supplement Claims Transition to Facets Effective January 2024

Effective January 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is transitioning its Medicare Advantage and Medicare Supplement claims operations to the Facets system, which will enable Blue Cross NC to utilize one system for all members.

As a result, current members will receive new member IDs and ID cards in December 2023 and should begin using them on January 1, 2024.

This includes all Blue Medicare HMO℠, Blue Medicare PPO℠, Blue Medicare Supplement℠, Blue Medicare Rx℠ (PDP), Blue Medicare Freedom+℠ PPO and Experience Health members. This includes those members whose coverage is renewed on January 1 or June 1. 

Key Actions for Providers:

1. Ask patients for their new ID cards starting January 1, 2024. New member IDs will be mailed to all affected members in December 2023.

Example ID card is shown below:

Additional Information about Medicare Advantage and Medicare Supplement Claims Transition to Facets

Submitting claims

We provide two methods of inquiry, one of which is a HIPAA X12 transaction and the other is through our Blue e portal that will assist providers with verifying members’ coverage. If a member does not have their ID card at the time of service, we ask providers to not deny members treatment, bill them upfront or reference them as self-pay prior to completing verification through Blue e.

• If a provider does not have an ID card for a member, Blue Cross NC provides two methods of inquiry to obtain the information. A HIPAA X12 270 inquiry transaction may be sent with a Name and DOB only, as well as the plan year 2024 as the date of service, and Blue Cross NC will respond with a 271-response providing information for the January 1, 2024, effective policy.  Providers can also perform a similar search using the Blue e Health Eligibility transaction by entering the first and last name and DOB with a 2024 date of service and the response will provide the effective coverage for the benefit period requested.
  
  The eligibility response will contain the new member ID, policy, and benefit information relative to the date of service used for that plan year.
  
  
• If a member continues to present their old ID card, after January 1, 2024, the member’s Blue Cross NC coverage status will show as inactive at the point of service, and claims will not be processed correctly. Members or providers will need to re-submit claims using the member’s new ID number for the members’ benefits to be applied correctly.
  
  
• When filing run-out claims for 2023 use the current 2023 member ID. The new member ID should be used for dates of service January 1, 2024, and after. Using the old ID on claims with January 1, 2024 and beyond will cause a claim to be rejected. Using the new member ID on claims with dates prior to January 1, 2024 will also reject. If you need to file a claim with dates that span the 2023/2024 years, please use the member ID in effect on the start date of service or split the claim.

Authorizations

• If a provider requires an authorization for an admission or service prior to January 1, 2024, but the admission or service is performed/takes place after January 1, 2024, either inpatient or outpatient, the provider should provide the member’s new ID number. Blue Cross NC will confirm member’s eligibility for the given procedure for January 1, 2024, and after. 
  
  
• If the provider does not have the member’s new member ID number, the provider should provide the member’s current member ID and Blue Cross NC will try to confirm the member using other data elements and identifiers.
  
  
• If the member is not shown as enrolled in our plan, we will not be able to provide an authorization until we receive their eligibility information, and it is loaded in our system.

Changes to member ID cards

Current members will receive new member ID cards in December 2023 and should begin using them on January 1, 2024, to ensure their claims process correctly. 

• This includes members whose coverage renews on January 1, 2024 (Medicare Advantage, Medicare Part D and Experience Health members) as well as members whose coverage renews on June 1, 2024 (Medicare Supplemental members). 
  
  
• The new member ID cards will consist of the following: 
  • The 3-character prefix “YPW” followed by a 9-digit member ID and a 2-digit member suffix. 
    
  • The last two digits of the member ID number will have a 00 suffix, instead of 01.
  • The group number will change from a six-character combination of letters and numbers to a new numeric eight-character value. 
  • Phone numbers and pharmacy information shown on ID cards will NOT change. 

* Sample numbers for illustrative purposes only; not representative of actual member IDs or group IDs

Planned member communications

• To help ensure members begin using their new ID cards in 2024, Blue Cross NC created multiple, phased communications to raise awareness and educate members, providers, and pharmacies of these changes. 
  
  
• Current members are receiving letters or emails (depending on the member’s communication preference), reminder postcards and social media posts that drive to a dedicated webpage:
  • Blue Cross NC Medicare webpage: BlueCrossNC/MyNewCard
  • Experience Health webpage: BlueCrossNC.com/MyNewMemberCard