Electronic Claims

Electronic Claim Submission-Maximizes Claim Processing

Electronic claim submission maximizes claims processing efficiency and paper submissions do not. Any claim that can be submitted on paper can be submitted electronically. If you need more information on how to submit claims electronically call 1-800-AVAILITY
(282-4548) or log on to Availity.

Advantages of Submitting Claims Electronically

The information required to file electronic claims is the same as for paper claims but there are major advantages to submitting electronic claims versus paper claims:

  • You have better control and accuracy. Electronic claims are entered in the BCBSTX’s computer system just the way they leave your office. There is no need to worry about a claim being delayed or denied because it is not legible.
  • You know when your claims are received because your office receives special reports detailing which claims were accepted and if there is a problem you can correct it before the claim is processed.
  • You are able to reduce your overhead; electronically submitted claims can save hours of clerical time. You do not have to spend time typing, stapling, stamping and mailing.

What To Submit Electronically

As a guideline, the following claims may be submitted electronically:

  • All original claims
  • All BlueCard (out-of-state) claims
  • Late Charges (Use appropriate indicator.)
  • Corrected Claims (Use appropriate indicator.)
  • Duplicate Claims (Use appropriate indicator.)
  • Medicare Supplemental Claims that do not automatically crossover.*

* If your Medicare B Remittance Advice or electronic RA does not indicate the claim was forwarded to BCBSTX. Do not submit attachments or Explanation of Medicare Benefits (EOMBs) unless requested by the claim processing unit.

Disadvantages of Submitting Paper Claims

  • The chances that your paper claims will be manually keyed due to form deviation are very high. There is great variety in the UB-04 and CMS 1500 forms that we are receiving. When the form that you are using is not up to US Government Printing Office specifications, the claim must be manually processed and will be delayed.
  • Once the claim has to be manually keyed, there is an increased potential for error due to undecipherable text and manual intervention.
  • You should never routinely file a paper claim as an exact duplicate of an electronic claim. This second (tracer) claim creates additional investigation for both claims which lengthens the claim processing time and ultimately delays payment.

NOTE: You should carefully review your electronic claim response reports to ensure that all of your electronic claims were accepted into our system. Rejected claims should be corrected and resubmitted electronically. Resubmission of claims accepted into our system will cause the new claim to be rejected as a duplicate and delay the entire adjudication process. Using our automated claims inquiry functions for claim inquiries will provide verification that your claims have been accepted and are in the processing system.