CORRECTION: Notification about submitting itemized bills

One of the greatest responsibilities Empire BlueCross BlueShield (Empire) has to our members is to administer their benefits accurately. We conduct prepayment itemized bill reviews for inpatient and outpatient services to ensure member cost shares are correctly applied. We have recently made the determination that our members would be best served if we were to require itemized bills for inpatient services billed in excess of $100,000 and outpatient services billed in excess of $50,000.

On October 1, 2023, you will be required to make a change when submitting itemized bills for Empire inpatient and outpatient member claims:

• For inpatient services, submit an itemized bill for member claims in excess of $100,000.
• For outpatient services, submit an itemized bill for member claims in excess of $50,000.
• The itemized bill should be equal to the amount billed in order for us to process the claim.

This change applies to all Commercial members.

We want to reduce the impact to your billing area as much as possible, so we have introduced a process that will:

• Reduce the time needed to identify a fully insured member.
• Eliminate the need to submit itemized bills when not needed.
• Integrate with your existing workflows to enable electronic submission.

Empire’s Digital Request for Additional Information (Digital RFAI) process enables you to submit itemized bills electronically through Availity Essentials.* This is the most efficient way to submit itemized bills, and here is how it works:

1. You submit your claim through either EDI or the Claims & Payments application on Availity.com.
2. If an itemized bill is needed, in most cases we send a notification to your Attachments Dashboard on Availity.com each morning by 8 a.m. Eastern.
3. You retrieve the notification and upload the itemized bill directly to your claim as an attachment.

If an itemized bill is not required for the claim, you will not receive a digital notification, and the claim will continue through processing unless the claim is processed through an alternative system. In those rare cases, you will still receive a paper notification. There is no change to the Greater New York Hospital Association (GNYHA) process.

Another benefit of the Digital RFAI process is the affected claim lines will pend (rather than deny), allowing up to 30 days for you to supply the requested itemized bill.

Access the Digital RFAI webpage for information, learning resources, pre-recorded demonstrations, and more:

• Start by viewing the Digital Request for Additional Information Training session. For help setting up Medical Attachments on Availity.com, access this video for additional instructions.
• Not registered with Availity Essentials? Here’s a link to get started with Availity.