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New Online Member Liability Estimator for Institutional Providers

February 10, 2012

We are pleased to announce that the Availity®’ CareCost Estimator (CCE) tool has been launched for contracting institutional providers in Texas. Contracting professional providers have had access to the CCE tool since late 2010.

For institutional providers, the CCE will review the available information submitted: primary diagnosis, procedures performed, available benefits, and contractual allowances. The CCE will calculate an estimated out-of-pocket cost in real-time for inpatient and outpatient services provided to Blue Cross and Blue Shield of Texas (BCBSTX) members.**

Using this free online member liability estimator (MLE) tool can help provide greater transparency regarding a member’s potential out-of-pocket costs, giving you the option to decide if you would like to collect the estimated member’s share at the point of service. The CCE tool is available only to registered Availity users and may be accessed only via the Availity Web portal. This MLE function is not available via BCBSTX Customer Advocates on the phone or through our automated Interactive Voice Response (IVR) phone system.

Remember—the CCE is exactly that—an “estimator.” This means that the CCE tool provides an estimate of the member’s liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is

processed. The CCE does not provide preauthorization or any guarantee of payment. If the actual dollar amount collected from the member is greater than the amount owed, the provider will be obligated to promptly refund the overpayment to the member once the claim has been processed,.

The new Availity CareCost Estimator Tip Sheet for contracted institutional providers is now available in the Education and Reference/Provider Tools section of the BCBSTX Provider website at bcbstx.com/provider. View the new CareCost Estimator Tip Sheet for institutional providers for complete details on exceptions and other limitations of this new tool. A CareCost Estimator Tip Sheet for professional providers is also available in the Education and Reference/Provider Tools section of our Provider website.

Registered users can also attend free Availity webinars to learn about the CCE tool and other Availity applications. For a current schedule of webinar offerings, just click on “Free Training” from any page after logging on to the Availity portal. To register with Availity, access the free CCE tool and learn about other options, visit availity.com. You may also contact Availity Client Services at 800-AVAILITY (282-4548) for assistance.

*The Estimator is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, benefits, limitations and exclusions, and the terms of the member’s certificate of coverage in effect on the date services are rendered. Accumulated amounts, such as deductibles, may change as additional claims may have been processed after the estimate was provided.

**See the CCE Institutional Tip Sheet for a brief list of exceptions.

Availity is a registered trademark of Availity, L.L.C., an independent, third-party vendor. Availity is solely responsible for all of its products and services, including the CareCost Estimator.