01-30-2024
The Claim Inquiry Resolution (CIR) tool within the Electronic Refund Management (eRM) portal accessed via Availity® Essentials only accepts inquiry submissions related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) claims (Medical Records and/or Itemized Bills). The other inquiry options that were available via CIR have transitioned to the Availity Claim Status Tool’s Dispute Claim or Message This Payer features.
Important: As of January 27, 2024, any request submitted through CIR that is not for High-Dollar, Pre-Pay Reviews will be rejected.
Watch for updates to the CIR Tool page and user guide to reflect these changes, coming soon.
Online Claim Review Options
For claim review inquiries previously handled under CIR, providers should use the online Claim Status tool’s Dispute Claim or Message This Payer options. Both functions are available after performing an Availity Claim Status search by utilizing the Member and/or Claim Number tabs. Using these capabilities ensures that the claim review inquiry is handled as priority over faxed or mailed receipts.
The below information provides an overview of the Dispute Claim (Claim Reconsiderations) and Message This Payer options.
Dispute Claim – Claim Reconsiderations
A claim reconsideration is a request to review and/or reevaluate situational finalized claim denials online (including BlueCard out-of-area claims). This type of inquiry submission is the preferred method as it allows you to upload supporting documentation and monitor the status.
Use this online offering to....
o Manage status
o Upload supporting documentation with your submission
o View and print the confirmation and decision
o Generate a dashboard view of claim reconsideration request activity
o View uploaded documents after attaching them to the request*
*Note: Uploaded attachments may take minutes to hours before they are viewable in the request.
For more details, refer to Claim Reconsiderations under Provider Tools on the provider website and includes an instructional user guide.
Claim Reconsiderations is not currently available for Texas Medicaid or Medicare Advantage claims.
Message This Payer
The Message This Payer option allows you to send secure messages to BCBSTX for claim management questions and follow along with the conversation history. Once a message is submitted to BCBSTX, you will receive a response within two business days in the Messaging que on the Availity Essentials homepage.
Use this online option to…
o Initiate a message to BCBSTX from the Availity Claim Status tool
o Receive an online response from a BCBSTX associate
o Monitor message status via a dashboard view
o View and print conversations
For more details, refer to Message This Payer on our website which includes an instructional user guide.
Message This Payer is not currently available for Texas Medicaid, Medicare Advantage or BlueCard (out-of-area) claims.
Attend Instructor-Led Training Webinars
Visit our provider training page to register for upcoming training session(s) to learn more about electronic tools available to help you streamline claim review processing.
You must be registered with Availity to gain access to Claim Reconsiderations via Dispute Claim or Message This Payer applications. Not an Availity Essentials registered user? Go to Availity and complete the online guided registration process, at no cost. If you need help with Availity registration, contact Availity Client Services at 800-282-4548.
For more information:
Email our Provider Education Consultants if you have any questions on accessing these tools or need customized training.
Continue to watch our Blue Review and News and Updates for future announcements, resources, and training opportunities.
If you do not have Availity access, visit our provider website for information on submitting claim review requests.
Availity is a trademark of Availity, LLC, 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 provided by third party vendors and the products and services they offer.