State PPO

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State PPO

• Payroll / Billing HBR Workshop

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Agenda

• Billing
• PPO Updates
• Questions

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Glossary of Terms for State PPO

• GROUP NUMBER Identifier for members enrolled in
  a particular group. For
• State PPO a group number represents a specific
  State agency, school or population such as
  Retirees.
• ACCOUNT NUMBERThe account number provides
  additional flexibility to sub-categorize group
  information for reporting, billing, and
  reconciliation purposes.
• Some State agencies request a break-out by
  department
• BENEFIT PACKAGE For State PPO 3 plans are
  offered
• 11BO Smart Choice Basic
• 11BN Smart Choice
• 11BP Smart Choice Plus
• TIER Type of coverage selected by employee
• Single coverage (SNGL),
• Employee spouse coverage (SBSP),
• Family coverage (FMLY),
• Employee plus children (SBDS)

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Comparison of Terms
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Membership Hierarchy
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Group Invoice Example
Agency or Group Name Contact Name Address

A
B
D
E
F
G
H
I
J
C
Verbiage Under Development
K
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Group Invoice Example

• Identification number
• Employee Name
• Employee Status
• Billing From Date
• Billing Thru Date
• Benefit Package selected by employee
• Tier of coverage selected by employee
• Amount of premium from agency
• Amount of premium from employee (payroll
  deduction)
• Total amount due from agency for that employee
• Total amount due from agency for all employees

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Debits / Credits Invoice Example
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Differences

• Invoices
• PPO invoices will be separate from Indemnity
  invoices
• PPO invoices will be easily distinguished from
  the Indemnity invoices
• PPO invoices will have a BCBSNC logo
• New billing invoice summary page
• Reconciliation Statement includes Activity Codes
• The Remittance Statement will be on a separate
  page
• Reconciliation
• Recommend that the bill is paid in the amount
  issued
• Maintenance should not be held to submit with
  remittance
• Balance Forward Billing

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Billing Invoice Summary
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Reconciliation Statement
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Remittance Statement
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New Remittance Addresses

• Payee is new for PPO
• Remittances should be payable to NC State Health
  Plan PPO
• Remittance address is new for PPO groups and
  charter schools

New
New
PPO Premium Payment Remittance All Groups Except
Charter Schools
PPO Premium Payment Remittance Charter Schools
Only
Blue Cross and Blue Shield of North Carolina Post
Office Box 30088 Durham, NC 27702
Blue Cross and Blue Shield of North
Carolina Post Office Box 1809 Durham, NC 27702
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Movements Accumulators
     
     
PPO Product Movement Rules  
PPO Product Movement Rules  
 
 
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Forms

• Indemnity and PPO Forms will be Combined
• Change Form
• Enrollment Application
• Certification of Dependent Eligibility
• Coverage Request for Incapacitated Dependent

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Future Functionality

• eBilling Presentment
• EDT

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Review of Supplementary Materials

• CMM to PPO Groups Number Mapping
• Benefit Package Tier Mapping

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Review of Supplementary Materials
CMM to PPO Group Number Mapping
Sample
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Review of Supplementary Materials
Benefit Package Tier Mapping
Sample
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Questions?