Effective July 11, 2016, corrected claim requests for previously submitted electronic and paper claims can no longer be initiated by calling Provider Customer Service. Additionally, these requests will not be accepted via the Claim Inquiry Resolution option in our Electronic Refund Management (eRM) tool.
The Blue Cross and Blue Shield of Texas (BCBSTX) claim system recognizes claim submission types based on claim frequency code submitted on professional (837P) and institutional (837I) electronic claims. Replacement claims (sometimes referred to as corrected claims) submitted electronically are identified by using claim frequency code 7; voided or canceled claims are identified by using claim frequency code 8. Please note that the electronic replacement claim will replace the entire previously processed claim. Therefore, when submitting a correction, send the claim with all changes exactly how the claim should be processed.
To learn more about these changes, register today for an upcoming webinar:
July 20, 2016 - 2 to 3:30 p.m.
July 27, 2016 - 2 to 3:30 p.m.
Aug. 9, 2016 - 2 to 3:30 p.m.
Aug. 23, 2016 - 10 to 11:30 a.m.
Over 98 percent of the claims received from our providers are submitted electronically. BCBSTX encourages our providers to consider the web as the primary resource for administrative inquiries. There are several multi-payer web vendors available to our providers or they can visit availity.com to register for a no cost solution.
BCBSTX requires "corrected claim" to be indicated on the Claim form or on the Claim Review form when submitting corrections on a paper claim. Effective July 11, 2016, any changes to a claim that are indicated only on the Claim Review form or via a letter will be returned with a notice advising resubmission on the appropriate professional (CMS-1500) or institutional (UB-04) paper claim form. The Claim Review form is available in the Education and Reference/Forms section of our Provider website. Refer to the form for additional instructions.
Additional information will be included in upcoming issues of Blue Review, as well as the News and Updates section on our website at bcbstx.com/provider.