March 2018

Helpful Tips for Preventing Claim Delays

On a recent review of claim denials, Blue Cross and Blue Shield of Oklahoma (BCBSOK) identified the most common issues that cause delays in claim processing.

Following the tips below will help prevent delays, billing errors and other potential setbacks that could cause postponements in payments.  

• Verifying benefits can be helpful prior to submitting claims or appeals in order to have the most current policy information, as well as any benefit exclusions that may be relevant to the services being rendered.
• Obtaining a copy of the member’s current insurance card at all visits, as policies can often change. This will ensure that the claims are submitted with the most current policy information.
• Verifying the correct alpha prefix is on all claims — this is extremely important. Many claims cannot be processed without the member’s alpha prefix.
• If there are two Blue Cross and Blue Shield insurance policies for a member, please be sure to include both the primary and secondary policy information on the claims.
• If a corrected claim is needed, providers have two options. Providers can submit corrections electronically. For instructions on how to submit corrections electronically visit the BCBSOK provider website in the Education and Refence Center/Claim Tips/ Related Resources. If a provider is unable to submit corrections electronically they can submit a Corrected Claim Form. The Corrected Claim form can be found under the Claims section of the Education and Reference Center/Forms on the BCBSOK Provider website. For other questions about corrected claims requests review the Corrected Claims Request Frequently Asked Questions.
• Be sure to include all current and complete provider information on the claims, including the current tax identification number and NPI numbers in the correct fields.
• If a response has not been received to a claim, please contact Customer Service at 800-496-5774, or check the Availity^TM website for claim status prior to resubmitting the claim. If the claim is already on file, but has not yet been processed, a resubmission will not expedite the processing of the original claim.

For more claim tips and helpful resources, visit the Claim Tip section on the bcbsok.com/provider website.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.