Blue Review
A newsletter for contracting institutional and professional providers

September 2019

New and Exciting Functionality Coming to the Claim Research Tool (CRT) via Availity® Provider Portal

The CRT provides enhanced, real-time claim status details to help you manage and resolve your Blue Cross and Blue Shield of Illinois (BCBSIL) claims electronically. As of Aug. 26, 2019, the CRT now returns out-of-network patient responsibility in the service line details. This enhancement helps you identify if the patient liability was applied to the out-of-network co-payment, coinsurance and/or deductible.

Effective Sept. 23, 2019, two additional features will become available.
First, the CRT will be enhanced to offer greater specificity for Cotiviti, INC. (formerly known as Verscend) claim denials. Once implemented, you will see the Cotiviti code-auditing logic descriptions for finalized claims. These expanded claim details will be available for claims finalized Aug. 26, 2019, and after.

Second, you will see additional action(s) that will provide instruction for specific denials for finalized claims. These instructions will help providers understand what further action may be needed as a result of how the initial claim processed.

CRT Reminders:

  • The CRT is not yet available for government programs (Medicare Advantage and Illinois Medicaid) claims.
  • Locate duplicate claims, along with the original by performing a Patient ID search.
  • When using the Patient ID search to locate Federal Employee Program® (FEP®) claims, use group number 0FEP00.
  • When using the Patient ID search to locate out-of-state member claims, use generic group number 123456.
  • Claim adjustments are identified by a two-digit suffix on the claim number. For example, claim number 123456789D10X00 indicates it is an original submission. Claims ending with suffix 01 indicate the claim has been adjusted once.

For additional information, refer to the CRT tip sheet. As a reminder, you must be registered with Availity to use the CRT. For registration information, visit availity.com, or contact Availity Client Services at 800-282-4548.

Stay Informed! Continue to watch for future News and Updates announcements and helpful resources.

If you have questions about these enhancements, contact our Provider Education Consultants team at PECS@bcbsil.com.

Cotiviti, INC. is an independent company that provides medical claims administration for BCBSIL. Cotiviti is solely responsible for the products and services that it provides. 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 BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Cotiviti and Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.