Online member liability estimator now available
    
The Availity® CareCost EstimatorSM (CCE), developed jointly with Availity, is a member liability estimator* (MLE) tool. The CCE reviews the available information submitted: Primary diagnosis, procedures performed, available benefits, and contractual allowances. Then it calculates an estimated out-of-pocket cost in real time for office and outpatient services provided to BCBSNM members.**

Using this free online tool can help provide your practice with greater transparency about a member’s potential out-of-pocket costs, giving you the option to decide if you would like to collect the estimated member’s share at the point of service. The CCE tool is available only to registered Availity users and may be accessed only via Availity. It is not available via BCBSNM Customer Advocates on the phone or through our automated Interactive Voice Response (IVR) phone system.

Note: The CCE is an estimator. It provides an estimate of the member’s liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. The CCE does not provide preauthorization or any guarantee of payment. If the actual dollar amount collected from the member is greater than the amount owed, once the claim has been processed, the provider will be obligated to promptly refund the overpayment to the member.

A CCE Tip Sheet is available online. Registered users can also attend free Availity webinars to learn about the CCE tool and other Availity applications. For a current schedule of webinar offerings, select Free Training from any page after logging in to Availity.

To register with Availity, access the free CCE tool and learn about other options, visit availity.com. You may also contact Availity Client Services at 800-AVAILITY (282-4548) for assistance.

*The Estimator is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, benefits, limitations, and exclusions and the terms of the member’s certificate of coverage in effect on the date services are rendered. Accumulated amounts, such as deductibles, may change as additional claims may have been processed after the estimate was provided.

**See the CCE Tip Sheet for a brief list of exceptions.

Availity is a registered trademark of Availity, LLC, an independent third-party vendor. Availity is solely responsible for all of its products and services, including the CareCost Estimator.


Blue Review • December 2011 • bcbsnm.com