The Claim Reconsideration request option allows providers to electronically submit claim reconsiderations for situational finalized claim denials (including BlueCard® out-of-area claims), using Availity® Essentials Dispute Claim capability, which is anchored off the enhanced Claim Status tool. This method of inquiry submission is preferred over faxed/mailed claim disputes to BCBSTX, as it allows providers to upload supporting documentation and monitor the status – all online.
A Claim Reconsideration is a request to review and/or reevaluate a claim that has been finalized.
Please note: This electronic option is not currently available for Medicare Advantage or Texas Medicaid 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 the following:
- status management
- upload of supporting documentation with submission
- view and print confirmation and decision
- generates a Dashboard view of claim reconsideration request activity
- view uploaded documents after attached to the request*
*Note: Uploaded attachments may take minutes to hours before they are viewable in the request.
For details, refer to the instructional Claim Reconsideration Requests User Guide . Also see the Claim Status Tool User Guide for help with obtaining enhanced claim status online.
Questions on electronic options?
Email our Provider Education Consultants for assistance. Be sure to include your contact information, Tax ID number, and Billing NPI.
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.