Introducing Electronic Clinical Claim Appeal Requests via Availity^®

This month Blue Cross and Blue Shield of Texas (BCBSTX) will launch a new and convenient electronic capability to submit appeal requests for specific clinical claim denials through the Availity Provider Portal for commercial members.

This information is not applicable to Medicare Advantage, Medicaid claims or BlueCard^® (out-of-area) claims.

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 new online offering allows the following:

• status management
• upload clinical medical records with submission
• view and print confirmation and decision letter
• generates Dashboard view of appeal-related activity

Steps to submit appeal requests for clinical claim denials online:

1. Log into Availity 
2. Select Claims & Payments from the navigation menu, then choose Claim Status
3. Search and locate the claim by using the Member ID or Claim Number
4. On the Claim Status results page, select Dispute Claim (when applicable)
5. Complete the Dispute Request Form
6. Upload supporting documentation
7. Review and submit your appeal request

For assistance with obtaining claim status online, refer to the Claim Status Tool user guide .

Training

BCBSTX is hosting complimentary webinars for providers to learn how to use this new electronic appeals tool. To register for a training session, select your preferred date and time below.

Nov. 8, 2021 - 1 to 2 p.m.	Nov. 19, 2021 - 10 to 11 a.m.
Nov. 10, 2021 - 10 to 11 a.m.	Nov. 22, 2021 - 1 to 2 p.m.
Nov. 12, 2021 - 10 to 11 a.m.	Nov. 24, 2021 - 10 to 11 a.m.
Nov. 15, 2021 - 1 to 2 p.m.	Nov. 29, 2021 - 1 to 2 p.m.
Nov. 17, 2021 - 10 to 11 a.m.

Availity Administrators need to assign their users the Claim Status role in Availity to ensure users can access and submit electronic appeals online. If your provider organization is not yet registered with Availity, you can sign up today at Availity , at no charge. For registration assistance you may contact Availity Client Services at 1-800-282-4548.

For More Information

Watch for the Electronic Appeals User Guide coming soon to the Provider Tools section of our website. Visit the Educational Webinar Sessions page for additional webinar sessions that will be hosted in December. If you need further assistance, contact our Provider Education Consultant.

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.