Providers can utilize the Dispute Claim option to electronically submit appeal requests on commercial members for specific clinical claim denials using Availity Essentials.
When applicable, the Dispute Claim option is available in the Availity Claim Status tool results.
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 of the appeal
- upload clinical medical records with submission
- view and print confirmation and decision letter
- generates dashboard view of appeal-related activity to monitor status
For navigational assistance, refer to the Electronic Clinical Claim Appeal User Guide.
If you are not yet registered with Availity, sign up today at Availity , at no charge. If you need registration assistance, contact Availity Client Services at 1-800-282-4548.
Note: If you do not have Availity access, you may continue to submit your requests using the Claim Appeal form located on our provider website.
This information is not applicable to Medicare Advantage, Medicaid or BlueCard® (out-of-area) claims.
Questions on electronic options?
Email our Provider Education Consultants. Be sure to include your contact information, Tax ID and/or Billing NPI numbers.
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.