Starting on May 22, 2022, providers will have the option to electronically initiate one clinical claim appeal request for multiple claims when it is for the same patient and denial reason using the Availity® Claim Status tool.
As a reminder, a Clinical Appeal is a request to change an adverse determination for care or services when a claim is denied based on lack of medical necessity, or when services are determined to be experimental, investigational, or cosmetic.
Using this online offering allows the following:
- Status management
- Upload of clinical medical records with submission
- View and print confirmation and decision letter
- Generates Dashboard view of appeal-related activity
Training and Resources
- Refer to the Educational Webinar Sessions page to register for the “Claim Status and Clinical Claim Appeals” webinar hosted weekly by Blue Cross and Blue Shield of Texas (BCBSTX).
- View the Electronic Clinical Claim Appeals User Guide in the Provider Tools section of our website for step-by-step instructions.
- Contact our Provider Education Consultants if you have further questions or need customized training.
This information is not applicable to Medicare Advantage, Texas Medicaid, or BlueCard® (out-of-area) claims.
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 third party vendors and the products and services they offer.