Helpful Tips for Preventing Claim Delays

BCBSTX has identified the most common issues that can cause delays in claims processing.

Here are a few tips to keep in mind when filing claims:

  • When sending in requested documents, please place a copy of the letter as the 1st piece of documentation. This will help our department to get the requested documents to the appropriate area in a timelier manner. For example, when receiving a letter requesting medical records, attach a copy of BCBSTX letter then add the medical records and any supporting documentation behind the letter. This letter contains a barcode in the upper right corner to help ensure that the information you send is matched directly to the appropriate file and/or claim.
  • Verifying benefits can be helpful prior to submitting claims or appeals in order to have the most current policy information as well as any benefit exclusions that may be relevant to the services being rendered.
  • Obtaining a copy of the member’s current insurance card at all visits, as policies can often change. This will ensure that the claims are submitted with the most current policy information.
  • Verifying the correct three-character prefix is on all claims - this is extremely important. Many claims cannot be processed without the member’s three-character prefix.
  • If there are two BlueCross and BlueShield insurance policies for a member, please be sure to include both the primary and secondary policy information on the claims.
  • If a corrected claim is needed, it must be marked as “corrected claim”, and indicate what is being corrected. If the corrected claim is not marked as such, it may be denied as duplicate or the issue may not be resolved appropriately.
  • Be sure to include all current and complete provider information on the claims, including the current tax identification number and NPI numbers in the correct fields.
  • If a response has not been received to a claim, please contact Customer Service at (800) 451-0287, or check the Availity website for claim status prior to resubmitting the claim. If the claim is already on file but has not yet been processed, a resubmission will not expedite the processing of the original claim.