10/04/2023
Blue Cross and Blue Shield of Texas (BCBSTX) is excited to announce a convenient new way to submit claim reconsideration requests online for situational finalized claim denials (including BlueCard® out-of-area claims).
A claim reconsideration is a request to review and/or reevaluate a claim that has been finalized.
Starting mid-October, you can submit reconsideration requests electronically, using Availity’s® Dispute Claim capability, which is anchored off the enhanced Claim Status tool. This method of inquiry submission is at no cost, preferred over faxed/mailed claim disputes, as it allows you to upload supporting documentation and monitor the status – all online.
Please note: This electronic option is not currently available for Texas Medicaid or Medicare Advantage claims.
We encourage you to begin using the new method for claim reconsideration requests now, as the Claim Inquiry Resolution (CIR) tool will be modified to only accommodate certain claim scenarios. The claim reconsideration option should be used to inquire on a previously processed claim.
Using this new online offering allows you to:
- Manage status
- Upload supporting documentation with your submission
- View and print the confirmation and decision
- Generate a Dashboard view of claim reconsideration request activity
- View uploaded documents after attaching them to the request*
*Note: Uploaded attachments may take minutes to hours before they are viewable in the request.
Steps to submit claim reconsideration requests online:
- Log in to Availity Essentials
- Select Claims & Payments from the navigation menu, then choose Claim Status
- Search and locate the claim using the Member or Claim Number options
- On the Claim Status results page, select Dispute Claim (if offered and applicable)
- Select Reconsideration as the Dispute Reason
- Complete the Dispute Request form
- Upload supporting documentation
- Review and submit your claim reconsideration request
For help with obtaining enhanced claim status online, refer to the Claim Status Tool user guide.
Availity Administrators must assign users the Claim Status role in Availity Essentials to ensure users can access and submit electronic claim reconsiderations online. If your provider organization is not yet registered with Availity, you can sign up today at Availity, at no charge. For registration help, contact Availity Client Services at 800-282-4548.
For More Information
Refer to the Claim Reconsideration Requests page which includes the Claim Reconsideration Requests User Guide on the Provider Tools section of our website. If you need further education or assistance, contact our Provider Education Consultants.
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.