Provider Access System FAQ
Blue Cross of Jamaica Limited introduced the Provider Access System (PAS) in August 2000. This electronic system links participating providers to Blue Cross® for submission and retrieval of data related to subscriber eligibility, claims, status and benefits utilization. Providers only need to swipe the subscriber’s Blue Cross Care Card, to verify their authenticity and the value of the insurance coverage. This procedure makes all the information required immediately accessible.
Q. How can I become a PAS provider?
A. To become a PAS provider, you must first be a Blue Cross® participating provider. Requests are forwarded to Advanced Integrated Systems (AIS). They then make contact with the provider.
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Q. What are the terms and conditions of becoming a PAS provider?
A. Blue Cross® has a contract that all participating providers sign; AIS also has a contract, and we would be happy to make a copy of this available to you for your perusal.
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Q. Do I have to have PAS before I am enrolled as a new provider?
A. No. This is not a requirement.
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Q. Does BCJ have any financial assistance programme in place to make it easier to become a PAS provider?
A. We have offered assistance to some providers and would be happy to explore this for you, should you be interested.
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Q. Is there an alternate system to PAS and what of providers whose limited business does not make PAS a cost effective venture?
A. While Blue Cross® explores the long-term alternative, the Provider Voice Response System (929 3243) and the staff at the Help Desk (927-6811, 927-6839: for after work hours 995-6996) are available to offer eligibility checks prior to giving service.
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Q. Why didn’t BCJ use a simple system like First Life? Is it too late to change?
A. We are committed to our current system. It is our hope that as we work to refine the system you will find it more and more efficient.
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Q. Why are so many subscribers visiting providers without their swipe card? How should providers deal with these situations?
A. Blue Cross® has made every effort to ensure that all our subscribers are in possession of Care Cards. However, should a subscriber seek your services with only a paper card, we suggest that you use the Provider Voice Response System (VRS) or the Help Desk to ascertain eligibility.
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Q. Why doesn’t Blue Cross® put the photograph of the subscriber on the card?
A. Subscribers are encouraged to sign the back of their cards. We suggest that you match the signature to confirm the person’s identity. We have explored the possibility of issuing cards with photographs, but at this time it is not a practical solution.
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Q. In the past, Blue Cross® gave an incentive fee to their providers for completing claims, why not with PAS?
A. We hope that our PAS providers will consider the advantages of the system to be an incentive. The main ones are the guarantee of payment and the turnaround time of 7 working days for the receipt of cheques.
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Q. Why didn’t BCJ install the system in provider offices and then collect over a specified period of time?
A. Blue Cross® would not have been able to absorb this cost.
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Q. Why don’t the cards reflect the balance?
A. Like regular credit cards balances are not reflected. Subscribers are encouraged to save their slips and keep a balance of their benefit. Providers can obtain eligibility
by using the Provider VRS or the Help Desk.
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Q. Couldn’t the system be programmed to give a balance prior to the transaction?
A. This feature is being developed. It will soon be available to our providers.
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Q. Are there sufficient lines for the amount of providers and possible transactions?
A. We are currently installing additional telephone lines for your convenience. We will continue to monitor to ensure equitable distribution.
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Q. Why do we have to wait so long to get authorization from the PVRS?
A. The system is set up to respond in a matter of seconds. If you are experiencing delays, please let us have the details and we will investigate to ascertain the cause of this.
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Q. Could a landline be used instead of a cellular phone for calls after working hours? (The cost to the provider is too much.)
A. This service is being reviewed to guarantee efficiency. Presently, various staff members who work on shifts operate the service. They are not physically located on the Blue Cross building. If we use landlines, then persons who are off duty would receive calls.
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Q. Is payment guaranteed when authorization is given on either PAS or PVRS or by the Help Desk?
A. For PAS and the Help Desk, payment is guaranteed. Authorization received via the PVRS is subject to the receipt and adjudication of the paper claim.
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Q. Why is it that PAS throw you out so many times before the transaction is completed?
A. This could be due to a number of different factors, including problems with the telephone itself. It is important that you inform the supplier of your system as the problem could be one they could easily rectify. Otherwise, supply us with the details. We would be happy to investigate this.
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Q. Can BCJ do anything about the amount of cheques and the several sheets that the provider has to sign?
A. You could specify the frequency with which we should issue your cheques. We currently issue cheques on a daily basis. If you were to request weekly cheques, for example, then all the transactions for that period would be on one cheque.
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Q. Can we get a list of all the codes that are used and are related to providers e.g. NDC?
A. All relevant codes can be accessed on the system. If you do not know how to access them, please contact your supplier.
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Q. Why are providers told that they have passed the 90-day TAT, when in fact they resubmitted their claims before the end of this period?
A. We ask that you submit your claims promptly, as well as your re-submissions within 90 days of the service date. Claims are usually settled if this is done.
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Q. Why does it take so long for resubmitted claims to be settled?
A. Resubmitted claims have to be researched before a decision to pay is made, hence the possible delay. As more persons use PAS, we expect to see a significant reduction in resubmissions.
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Q. Why are providers expected to pay transaction fees and GCT after paying so much for PAS?
A. The PAS system is owned and operated by external suppliers e.g. Advanced Integrated Systems (AIS). These suppliers collect the transaction fee. The GCT is now a requirement of the government.
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Q. Should all these costs be passed on to the subscribers?
A. Providers need to look at their costs of operating and may in some cases have to make adjustments in their charges.
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Q. Is that a fair reflection on subscriber/group utilization? (Sometimes providers are also subscribers on BCJ.)
A. We recognize the high costs accompanying the system, but believe that there will be savings as more persons use their Care Cards. There should therefore be an overall improvement in our client’s utilization in the long run.
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