BCBS of Texas Updates

Government Programs: New Tool for Verifying Claim Status in Availity

This notice applies to providers rendering services for the following Blue Cross and Blue Shield of Texas (BCBSTX) government program members:

• Texas Medicaid STAR, STAR Kids and CHIP

• Blue Cross Medicare Advantage (HMO)SM and Blue Cross Medicare Advantage (PPO)SM

A new claim status tool within the Availity Provider Portal has been added to help with getting claim details online. Instead of using the Claim Status Inquiry tool, government program providers can now obtain claim processing details by using the new Claim Status and Remittance Inquiry tool. Important claim status information is now available within a few clicks, lessening the need to speak with a Customer Advocate. As a reminder, you must be registered with Availity to use the Claim Status and Remittance Inquiry tool. For registration information, visit availity.com or contact Availity Client Services at 800-282-4548.

How to access and use the new claim status tool via Availity:

• Log in to availity.com

• Select the “Claims & Payment” tab from the main menu and then select “Claim Status and Remittance Inquiry”

• Next select “Claim Status”

• Choose the applicable government program payer from the drop-down list

• Enter the essential provider, patient and claim data

Additional Support

Learn how to use this new Availity tool by attending an Availity 101 training webinar hosted weekly by BCBSTX. If you need assistance or customized training, email our Provider Education Consultant team at PECS@bcbstx.com.

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.


How to Keep the Cash Flowing: Billing BCBSTX Medicaid as a Secondary Insurance

To keep the cash flowing, it’s important to understand secondary billing. When applicable, Blue Cross and Blue Shield of Texas (BCBSTX) coordinates benefits with other carriers and programs that a member may have for coverage, including Medicare. You will need to indicate ”other coverage” information on the appropriate claim form if BCBSTX is the secondary payer.

If there is a need to coordinate benefits, include at least one of the following items from the other carrier or program when submitting a Coordination of Benefits (COB) claim:

    • Third-party Remittance Advice (RA)
    • Third-party letter explaining the denial of coverage or reimbursement

COB claims received without at least one of these items will be returned to you with a request to submit to the other carrier or program first. Please make sure that the information you submit explains any coding listed on the other carrier’s RA or letter. We cannot process the claim without this specific information.

BCBSTX must receive COB claims within 95 days from the date on the other carrier’s or program’s RA or letter of denial of coverage. When submitting COB claims, specify the other coverage in:

    • Boxes 9a-d of the CMS-1500 claim form
    • Boxes 58-62 of the CMS-1450 (UB-04) claim form

If the member has BCBSTX Medicaid as secondary and you need to file electronically please ensure the following is included:

  • The other carrier’s information
  • Primary payer payment/ adjustment information

If you have questions about how to file secondary claims with BCBSTX, reach out to BCBSTX’s E-business consultants at PECS@bcbsil.com. If you need assistance from Availity® — BCBSTX’s claims clearinghouse, please call 1-800-282-4548 or visit availity. com. If you use a different vendor, please contact them with your questions about filing BCBSTX as secondary.

Please remember that if a commercial payer exists, then Medicaid is always the payer of last resort. Additional funds will pay up to the Texas Medicaid fee schedule.

Claim Filing with the Wrong Plan If you file a claim with the wrong insurance carrier and then provide documentation verifying the initial claim filing was within 95 days of the date of the other carrier’s denial letter or RA form, BCBSTX will process your claim without denying it for failure to file within filing time limits.

Claim and Billing Guidelines can be found in Chapters 5-7 of the STAR Kids provider manual and Chapters 6-8 in the STAR/CHIP manual.

If you have any questions regarding this process, please contact the BCBSTX Medicaid Network Department at 1-855-212-1615.