Blue Cross and Blue Shield of Texas (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:
- Electronic filing is the fastest and most convenient way to file claims. Refer to the Electronic Commerce page on the provider website for information on filing claims through Availity®. If you must file a paper claim, use the current version of the CMS-1500 for professional claims and the UB-04 for facility providers. For additional information on using these claim forms, visit the National Uniform Billing Committee (NUBC)
website. - When sending in requested documents, please place a copy of the letter as the 1st piece of documentation. This will help 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 is imperative prior to submitting claims or appeals in order to have the most current policy information, benefit exclusions and preauthorizations requirements relevant to the services being rendered.
- Obtain 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.
- Verify 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 use the appropriate bill type XX7 for institutional claims.
- 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 1-800-451-0287, or check the Availity website for claim status before 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.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Texas (BCBSTX). BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third-party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.