9.0 Pacific Blue Cross Claim Statements

9.1 Overview

Pacific Blue Cross will issue a statement to the Provider outlining Claim payment details. If you have registered for PROVIDERnet you can access your Claim statements through your account. If you do not have PROVIDERnet you will receive paper Claim statements.

Understanding Your Statement

The details of the statements are outlined below:

Header Information

1. Provider Name and Address	This is your mailing address.
2. Date	The date the statement was produced.
3. Your ID Number	Your Pacific Blue Cross Provider ID.
4. Page Number	Current page of the statement.
5. Cheque number/direct deposit Number	The payment number that appears on a physical cheque attached to the statement or on the Electronic Funds Transfer (EFT) statement.

Health Claim Summary

6. Total Amount Claimed	The total amount of each of the Claims for all Members on the statement.
7. Amount Paid by PBC Plan	The total amount covered by the Policy.
8. Total Payment Amount	The total payment amount once any Co-payments and Deductible have been satisfied.

Claim Details

Field	Description
9. Claim ID	The number assigned to each transaction.
10. Service Date	The date shown is the exact date the Equipment or Services were purchased.
11. Qty	The quantity.
12. Product or Service	The description of the Equipment or Services.
13. Claimed Amount	The total cost of the Equipment or Services.
14. Eligible Amount	The amount that is an Eligible Expense.
15. Deductible Amount	The amount applied to the Deductible under the Policy (if applicable).
16. Co-payment Amount	The portion the Member pays out of pocket.
17. Percent Covered	The percentage of the total cost of the Equipment or Services that is covered under the Policy.
18. Plan Paid Amount	The amount paid under the Policy.
19. Message Code	The explanation of Claim payment or reason for refusal.
20. Policy Number	This identifies the Policy.
21. ID Number	This identifies each Member.
22. Patient Name	The name of the primary individual eligible under the Policy, or their dependents.

9.2 Sample Statement

This is a sample statement showing the typical layout and information you will receive.

C5214 - Payment has been reduced as the maximum amount paid for this benefit has been reached.

Each statement provides a detailed breakdown of all claims processed during the payment period. Keep these statements for your records and reconcile them with your claim submissions.

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