November 20, 2020
This edit has been delayed. For details, please refer to the announcement article.
In the March 2020 News and Updates, we announced that, as of April 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) would start implementing new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions).*
Starting in December 2020, duplicate claim validation edits will be implemented for commercial 837P and 837I transactions when submitted to BCBSTX. Upon implementation, you may see new duplicate claim rejection messages on the response files from your practice management/hospital information system or clearinghouse vendor(s).
If you receive a duplicate claim rejection, the affected claim will not be found in our system, as BCBSTX does not create claim numbers (document control numbers) for rejected claims. To verify real-time status of the original claim number, use the Search by Member option in the Availity® Claim Status tool. For navigational help, see the Availity Claim Status user guide on our Provider website.
If you have questions regarding an electronic claim rejection message, contact your practice management/hospital information system software vendor, billing service or clearinghouse for assistance.
*This new duplicate rejection edit does not apply to Medicare Advantage or Texas Medicaid electronic claim submissions.
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 any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.