Important Change for Claim Status Requests

Effective Aug. 1, 2013, claim status will be available exclusively through the Blue Cross and Blue Shield of Texas (BCBSTX) automated phone system and electronic vendors, such as Availity^®’. We understand your need to speak with someone at times to resolve specific patient inquiries; therefore, our Customer Advocates will remain available for complex eligibility and benefit inquiries as well as claim adjustments when necessary.

Our automated phone system and the Availity Claim Research Tool are available at no cost to your organization. These resources provide real-time and detailed information pertaining to your finalized and in-process claims.

Claim status requests may include:

• Claim number
• Receipt date
• Processed date
• Date paid
• Amount paid
• Payee
• Line-item processing detail
• Check number
• Copay, deductible and coinsurance
• Total patient share
• Confirmation number/Transaction ID*

*Our automated phone system provides individual confirmation numbers for each inquiry; Availity provides Transaction IDs for each submission.

What is the Availity Claim Research Tool?
Registered Availity users may access the Claim Research Tool for enhanced, real-time claim status functionality to help manage and resolve BCBSTX claims. You can use this online tool to check status of multiple claims in one view, search claims for a particular date or date range, view claims according to status (such as paid, pended or denied) and verify detailed line-level information (such as amount paid, ineligible reason codes and detailed descriptions for each line of service).

The Claim Research Tool also:

• Displays monetary amounts from Medicare, other carriers and Health Care Accounts (HCAs) that have been applied to any claim; and
• Shows the specific item(s) required to complete the processing of a claim when additional information is requested.

For assistance with navigating the Availity Claim Research Tool, refer to the tip sheet in the Education and Reference and Reference/Provider Tools section of the BCBSTX provider website at bcbstx.com/provider.

Need customized training?
We’re eager to share the advantages these complimentary tools can offer. If you are interested in learning more, email our Provider Education Consultants at pecs@bcbstx.com. Please include your name, provider organization, billing NPI (or Tax ID) and business phone number so that we may contact you to make arrangements for customized training.

Availity is a registered trademark of Availity, LLC. Availity is a partially owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. Availity operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX, a Division of HCSC. Availity is solely responsible for the products and services it provides.