New Electronic Duplicate Claim Rejections for Commercial Claims Effective Nov. 14, 2020

December 15, 2020

In the March 2020 News and Updates, we announced that as of April 1, 2020, Blue Cross and Blue Shield of New Mexico (BCBSNM) would start implementing new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions).* Starting Nov. 14, 2020, duplicate claim validation edits will be implemented for commercial 837P and 837I transactions when submitted to BCBSNM. As of this date, you may see new duplicate claim rejection messages on the response files from your practice management system or clearinghouse vendor(s).

If you receive a duplicate claim rejection, the affected claim would not be found in our system, as BCBSNM does not create claim numbers (document control numbers) for rejected claims. Providers can verify real-time status of the original claim number, at no cost, by using the Search by Member option in the Availity® Claim Status tool. For navigational assistance, refer to the Availity Claim Status user guide found on our Provider website.

If you have questions regarding an electronic claim rejection message, contact your practice management/hospital information system software vendor, billing service or clearinghouse for assistance.

* This new duplicate rejection edit does not apply to Medicare Advantage or Blue Cross Community Centennial electronic claim submissions.

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 BCBSNM. BCBSNM 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.