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Pacific Blue Cross - Submitting Claims Through the PROVIDERnet Integration

Now that you have your Jane account integrated with Pacific Blue Cross, you’re ready to begin submitting claims - YAY!

If you’ve been previously tracking your Pacific Blue Cross claims in Jane, but submitting them through the PROVIDERnet portal outside of Jane, below are the steps to take to transition existing patient policies

If you’re brand new to submitting to Pacific Blue Cross, you can skip past this portion about transitioning insurance policies.

Transitioning Patient Insurance Policies

Your previous Pacific Blue Cross insurer and patient policies are not compatible with the integration, so each patient with a current Pacific Blue Cross policy will need a brand new insurance policy set up using the Pacific Blue Cross PROVIDERnet insurer. You will also want to remove the old versions of the policies from a patient’s upcoming appointments so that you can replace it with the new version. Current policies under your previous Pacific Blue Cross insurer can be edited and closed - even if a policy is closed, you can still receive any outstanding payments at a later date.

Creating a Pacific Blue Cross PROVIDERnet Insurance Policy

From your main schedule, if you click onto an appointment, you’ll see an option under Insurance Info to Add Policy

A list of available insurers will pop up for you to select from - here you’ll select Pacific Blue Cross PROVIDERnet.

To look up the PBC member, you’ll want to enter both the Policy Number and Identification Number. We’ve included an image of a typical PBC benefit card so that you can easily reference which number is which.

After entering the required numbers, click the blue button to Lookup Member Number

Below, you should see a list of members covered under that specific plan - select the member that matches the patient that received treatment.

If you accidentally select the wrong member, you can always edit and change that information.

When setting up a PROVIDERnet policy, you will also see a check box that can be used to indicate whether or not a Physician referral is on file. You only need to check this box to indicate that a referral is on file if that is a requirement of the patient’s plan.

If you’re setting up a policy for the first time, you’ll see the check box appear right below where you’re prompted to choose which plan member the policy is being created for.

If you’ve previously set up a policy for a patient, but a Physician referral is required in order to submit, you can now edit the policy and indicate below where the plan member is listed, that a Physician referral is on file.

Once this box is checked ‘on’, Jane will communicate to PBC that you have the referral on file and the claim should be processed without issue.

It is recommended that when a Physician referral is required, a copy of that referral should be scanned and uploaded to the patient’s chart in Jane in the event that PBC requires proof at a later date. For more information on scanning and uploading files to a patient’s chart in Jane click HERE

Within the claim, you no longer need to indicate % Coverage,Eligible Amount or Max Amount - Jane will take care of updating the amount covered for that visit and passing an applicable balance off to the patient as soon as the claim has been successfully submitted and PBC confirms the exact amount paid. When a claim is submitted, Jane will submit the full cost of the appointment which would have been the same if claims were being submitted through the PBC portal.

After saving the insurance policy, you should now see it attached to the appointment and you can add the applicable billing code and diagnosis/area treated.

Billing Code - the billing code selected needs to match the duration and type of appointment you’re billing for. So for example, if the patient received a 60 Minute Registered Massage Therapy treatment and it was not the patient’s first appointment, you would want to select 84816.

The necessary Pacific Blue Cross billing codes will have been pre-loaded into Jane for you but you can always review the available billing codes in your account. Head on over to Settings > Billing Codes to view these. You can also head to this section of your settings if you’d like to favorite certain billing codes that you frequently use by hitting the star on them.

PRO TIP: Not sure what billing code you need to use? Hit the space bar on your keyboard while in the billing code field and you can browse the selection of codes applicable to that appointment. Your favorited billing codes will populate the top of the list so you can easily select them.

Diagnosis - Similar to claims submitted through the Pacific Blue Cross portal, within Jane you are also required to indicate a diagnosis, or rather an area of the body that the patient received treatment on during that visit. In the field for diagnosis, you can simply type the name of the body part that was treated and select the option that best matches. If you’re currently billing claims through MSP/Teleplan, the same diagnostic codes that you’re using to submit Teleplan claims can also be used to submit claims to Pacific Blue Cross.

Your claim should now look similar to this :

And you can arrive the appointment.

Coordinated Pacific Blue Cross Coverage – If you have a patient who is covered under two different Pacific Blue Cross policies (eg. they have their own policy with Pacific Blue Cross, as well as their spouse’s policy) then you only need to add the primary policy to the appointment and submit just like that.

If there is a coordination of benefits, Pacific Blue Cross will communicate that to Jane and the secondary coverage details will automatically be added to the visit without you needing to do anything special.

For this reason, it is also important to ensure that the secondary Pacific Blue Cross policy is not already added to the appointment at the time of submission.

Submitting a Pacific Blue Cross PROVIDERnet Claim

Once the appointment is arrived, you should see a Submit button within the claim under Insurance Info.

After clicking the Submit button, you’ll want to review the details for the claim. Again, Jane will submit the full cost of the appointment for you so you should see that amount associated with the invoice.

At the bottom of the page, you’ll need to answer whether or not the claim is related to an Accident, ICBC case, Worksafe BC case or an out of Canada medical emergency. In general, claims that are associated with an accident etc. are not able to be directly submitted to Pacific Blue Cross.

After selecting one of those options, you can click the blue submit button and off your claim goes!

Within a few short seconds, you’ll receive the official claim response and it should look something like this :

Depending on the amount Paid, Jane will adjust the invoices to pass any remaining balance off to the patient and the insurer invoice will also be updated appropriately.

If that all looks good, you can close that window using the X in the top right corner and proceed with collecting any applicable patient payments using the Pay button.

Ta-Da! You’ve now successfully submitted a claim from your Jane account directly to Pacific Blue Cross.

If you’ve chosen to set up your integration to automatically Pay & Approve claims once a response has been received from PBC, you won’t need to do anything further with the claim.

If you’ve chosen to set your integration to leave the claims marked as submitted so that payment can be manually applied, you can refer to this guide document that reviews Receiving an Insurer Payment

In the event that a claim submission was made accidentally and you need to reverse the submission, this can also be done directly from Jane - Reversing Claims through PROVIDERnet

Disabling Electronic Submission

If you ever need to submit a claim directly on Pacific Blue Crosses’ portal, you can still record that claim manually in Jane. To start, head over to the Schedule tab and select the appointment.

Within the Appointment Panel, scroll down to the Insurance Info section.

Next, click on the dropdown arrow to the right of the Insurer Name in blue and select Disable Electronic Submission from the menu options.

From here, you can manually enter the total amount that Pacific Blue Cross is covering either in the Eligible or Max Amount field.

Lastly, click the dropdown arrow to the right of the Insurer Name in blue again and select Mark as SubmittedPay & Approve, or Record Payment in Detail.

As always, if you have any additional questions, our support team is here to help!

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