Provider Voice Response System

The Provider Voice Response system can be used to obtain a provisional authorization for services. It allows for interim claim processing, i.e., it reserves a balance for payment a balance for claim form for validation of the claim.

Upon presentation of the Blue Cross® CareCard you will be required to perform the following using a “touch tone” telephone keypad:

Dial Blue Cross’ toll freeProvider Voice Response (PVR) System at telephone number 1-888-3425-225.

Once a connection is made to the PVR, you will hear a welcome message followed by a series of instructions which will ask for the following :

• Provider Number
  Enter your participating provider identification number. This is the same number that you would normally record at the top right-hand corner of your paper claims.
• Group Number
  This is located in the centre, right hand column of the CareCard. Enter the last four digits only, e.g.,
  CareCard reads: 00344
  You will enter : 0344
  DO NOT INCLUDE THE FIRST ‘0’
• Member Number
  The member number is located in the top, left hand column of the CareCard and is in two segments. The member number commences after JAM0, e.g.,
  CareCard reads JAM00501697 001
  You will enter 0501697001
  DO NOT INCLUDE ‘JAM0’
  
  The first seven (7) digits represent the member number whilst the three following depicts the relationship to the member.
• Service Selection
  The PVR will determine from your provider identification number, the types of services you are likely to offer and will, for certain providers, navigate you through a menu of services.
• Select the relevant service.
  For example, an Optician will be asked to select whether his/her patient requires services for Examination, Lens or Frame benefits. In the case of a drug benefit, the PVR will ask how many items are being dispensed. You should indicate the relevant number of items being dispensed.
• Charge for Service
  The PVR does not recognize individual cents, you must therefore add two zeros to the end of any whole number, e.g., $3000.00 should be keyed as 300000. Entry of 3000 will be converted to $30.00.
  DO NOT INCLUDE THE DECIMAL POINT.
  
  The PVR will collate and process all the information you have provided and transmit this information to our central database for eligibility or provisional adjudication.
• Transaction Authorization Number
  If there are funds to cover the service and you wish to proceed with treating the patient, you will be provided with a Transaction Authorization number. This number must be clearly recorded on the paper claim that will be sent to Blue Cross® for payment.