Blue Review
A newsletter for contracting institutional and professional providers

May 2020

Get Claim Status Results in Real-time on the Availity® Provider Portal

Using the online options on the Availity Provider Portal provides a convenient, efficient and secure method of requesting detailed claim status from Blue Cross and Blue Shield of Illinois (BCBSIL). There are two Availity Claim Status offerings: one for commercial claims, and one for government programs claims submitted for our Blue Cross Community Health PlansSM (BCCHPSM), Blue Cross Community MMAI (Medicare-Medicaid Plan)SM, Blue Cross Medicare Advantage (HMO)SM (MA HMO) and Blue Cross Medicare Advantage (PPO)SM (MA PPO) members.

Results are returned in real-time, with more detailed information than the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard 277 claim status transaction. See below for a quick overview and links to learn more so you can add these tools to your workflow today.

 

For Commercial Claims:

For Government Programs Claims:

(BCCHP, MMAI, MA HMO, MA PPO)
Name of the tool

Claim Research Tool (CRT)

 Claim Status tool

Where to find it on Availity

Registered Availity users may access the CRT via the Claims & Payment menu in the Availity portal.

Registered Availity users may access the Claim Status tool via the Claims & Payment menu in the Availity portal.

Advantages of using these tools

Helps you manage accounts receivable by viewing details of a single claim or statuses of multiple claims for a specific member in one view. Allows users to obtain real-time claim status, with detailed ineligible reason code descriptions.
How to search The CRT allows registered Availity users to search for commercial claims by National Provider Identifier (NPI), patient ID, group number and date of service, or by NPI and specific claim number, also known as a Document Control Number (DCN). The Claim Status tool allows registered Availity users to search for government programs claims by NPI, member ID and date of service, or by NPI and specific claim number or DCN.
What’s returned

The CRT search results page delivers a detailed overview of how the claim processed, including the rendering provider ID and name submitted on the claim. Additionally, the claim status service line break-down returns:

  • Service Date
  • Revenue/Procedure Code
  • Diagnosis Code
  • Ineligible Reason Code and Amount
  • Copay, Coinsurance and Deductible
  • Modifier
  • Unit or Time or Mile

This Claim Status option provides you a detailed overview of how the claim processed, including with the following details:

  • Patient and provider data submitted on claims
  • In-network and out-of-network patient liability breakdown
  • Billing and rendering provider name and NPI
  • Check number, check date and payee name
  • Other carrier payment amount
  • Ineligible reason codes and associated descriptions
Who can use the tool? As a reminder, you must be registered with Availity to use these tools. To register, visit Availity, or contact Availity Client Services at 800-282-4548.
Helpful resources Refer to the CRT tip sheet on our website. Refer to the Government Programs: Claim Status Tool tip sheet
Educational webinars Join us for a webinar! BCBSIL hosts free Back to Basics: ‘Availity 101’ Webinars for you to learn how to use the CRT, Claim Status tool and other electronic options to the fullest potential. You do not need to be an existing Availity user to attend a webinar. To register online for an upcoming training, visit the Webinars and Workshops page.
Need help? Questions? Contact our Provider Education Consultants.

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 Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.