BCBSGA members may receive services from a health care provider that is also their employer. In some cases, these employers are self-funded, administrative services only (ASO) groups who contract with Anthem to administer health care benefits for their employees. For this type of arrangement, cashless payments apply as these self-funded employer groups pay themselves for the claim services incurred by their employees with no exchange of monies from the payer, BCBSGA.
On the 835 ERA, cashless payment is further defined by the Claim Adjustment Reason Code (CARC) of 139; Contracted funding agreement — Subscriber is employer by the provider of services. Review of the entire 835 ERA must be done to also account for when claims are zero paid due to uncovered services, exhaustion of benefits, or member liability. Currently, employee claim payments are combined with non-employee claims in a single 835 from Application Sender's Code NASCO (GS02). Changes are scheduled for mid-June to report cashless payments into a separate B835 identified by the BPR01, BPR02, BPR04 and TRN02.