MEMO TO: HEA Members

DATE: June 9, 1997

SUBJECT: IDA Customer Service

FROM: Joseph Cicchelli, Vice President

In order to receive assistance with a claim, please consult the following process:

  1. Contact the Customer Service Representative with I.D.A. (Insurance Design Administrators) at 1-800-225-1345, follow the "Automated Response System" enclosed and speak with a customer service representative.
  2. If the problem persists, ask to speak with a supervisor. If one isn't available at that time, one will contact you within a prescribed period of time.
  3. If a satisfactory resolution isn't achieved, contact our Field Service Representative from the Burton Insurance Agency, (201) 664-0310. Ms Debbie Ginetto. In her absence, ask Gary or Bill Kanwisher for assistance.
  4. If a satisfactory resolution still isn't achieved, a meeting will be scheduled between an I. D. A. representative, the claimant, and a representative from the Burton Insurance Agency. A complete evaluation of the claim will be performed at that time.
** It was explained to me that the plan does stipulate to the "exact coverage" as that provided by the State Health Benefits Plan. To expedite any claim discrepancy, it would be most helpful if a State Health Benefits Plan E. O. B. for the identical procedure can be located by the claimant that shows the exact same procedure performed by the exact same provider and the payments made on that claim. They would then be obligated to make the same payment on the current bill.**


IDA

1-800-225-1345

Accessing IDA's Customer Service Center
with
24 Hour Automated Interactive Voice Response System
(Touch tone phone required)


NORTH JERSEY SCHOOL HEALTH INSURANCE FUND
CLAIM SUBMISSION PROCEDURES


To Blue Cross Blue Shield               To IDA

ID cards & claim forms specify          ID cards & claim forms specify
where claims are to be submitted        where clains are to be submitted.

All Hospital & Facility claims          Hospital/Facilty and Physician
are to be directly submitted            Claims for Pascack Valley and
to Blue Cross Blue Shield, except       Wayne General are to be
for Pascack Valley & Wayne General.     submitted to IDA for processing.

Blue Cross Blue Shield will process     All Physicians and other Medical
all claims for Hospital & Facilities    Claims (Blue Cross participating
except for Pascack Valley & Wayne       and non-participating) are to be
General.                                submitted to IDA for processing.

Should a claimant receive a denial      Should a claim be submitted to
from Blue Cross Blue Shield             Blue Cross Blue Shield in error
regarding Pascack Valley or Wayne       and the claimant received a
General the claim should be re-         denial, then the claim (itemized
submitted to IDA for consideration      bill) and all appropriate in-
and payment. All appropriate in-        are to resubmitted to IDA for
formation for processing should be      processing by the Provider for
provided Blue Cross Blue Shield,        electronic claims only. Paper
where possible, will internally         Claim Submissions will be sent to
forward to IDA any Physician or         IDA by Blue Cross Blue Shield
other Medical Claims received in        before processing. These are sent
error. (claims that have been           to IDA weekly for processing.
received by Blue Cross Blue Shield
by hard copy)                           IDA will internally forward
Claims received electronically by       Hospital and Facility claims
Blue Cross Blue Shield will             received in error (except for
generate an EOB of denial in-           Pascack Valley and Wayne General)
structing the claimant to resubmit      directly to Blue Cross Blue 
all information and itemized bill       Shield's team for immediate
to IDA.                                 processing.

It is important that all participants in the Fund advise each provider at the time services are rendered where a claim is to be submitted by verbally telling the provider, showing their ID card and/or providing a claim form which also indicates the proper address for claim submissions.

It is also important for all participants to know and advise the participating Blue Cross Blue Shield provider rendering the services, that it is their understanding the provider is accepting assignment and no payment by the patient is due at the time services are rendered.

Billing is to be submitted directly to the appropriate Claims Processing Company, either Blue Cross Blue Shield or IDA (see ID card/claim form). Upon receipt of payment, the participaing Blue Cross Blue Shield provider can then bill for any additional payment, if applicable.


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