May 2017
Changes to the Paper Claim Review Form Process
As you know, the most efficient way to request a claim review for specific inquiries is electronically through the Claim Inquiry Resolution (CIR) tool, which is accessible on the AvailityTM Web Portal. However, for providers who need to submit claim review requests via paper, Blue Cross and Blue Shield of Texas (BCBSTX) has streamlined the process to facilitate more accurate processing of incoming requests. As previously notified in the article Upcoming Changes to the Claim Review Form, effective Jan. 1, 2017, written claim inquiries must be submitted on one of the specific Claim Review forms listed below.
Each Claim Review form must include the BCBSTX claim number (the Document Control Number, or DCN), along with the key data elements specified on the forms. These forms are available on our provider website in the Forms section. You can find detailed information on which form to use at the top of each form.
Links to New Claim Review Forms
Check Claims Status Online First
Though we have simplified the paper claims review submission process, checking claim status online is strongly encouraged prior to submitting claim review requests. The most effective way to determine claim status is electronically through your preferred web vendor, or by using the Availity Claim Research Tool. These electronic options provide the needed information in near real-time.
As indicated above, Availity users have access to the Claim Inquiry Resolution tool, which delivers a method of online assistance for specific inquiries on finalized claims. This tool is designed to help save you time by reducing the amount of calls and written inquiries submitted.
To learn more about these and other electronic options, visit the Provider Tools section on our website. For personalized online training regarding electronic tools, contact our Provider Education Consultants at PECS@bcbstx.com.
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 BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by 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.