As an alternative to phone calls or faxing forms, you can use the Claim Inquiry Resolution (CIR) tool via Availity® Essentials to submit claim reconsideration requests online for certain finalized claims. As a reminder, the CIR tool is in our Blue Cross and Blue Shield of New Mexico (BCBSNM)-branded Payer Spaces section at Availity.com.
Here are some tips to help you submit claim inquiries using the CIR tool:
- If your claim was processed within the last 18 months, select “Look Up Claim” on the inquiry screen to populate the Subscriber ID, Group Number, Patient Account, Patient Name and Date of Service on the next screen.
- If your claim processed prior to 18 months, select “Show More Fields” to manually enter this information on the next screen.
- Only include medical records when they are requested or required.
Claim number or document control number required: We will soon be rejecting inquiries that do not include an appropriate claim number, also known as a document control number (DCN) and will ask for a correct claim number. To avoid a rejected inquiry, please ensure your request includes an appropriate claim number/DCN.
CIR limitations: Users can employ this tool for finalized claims that require review relating to reasons outlined in the CIR user guide. The CIR tool cannot be used to:
- Obtain eligibility and benefit information
- Check claim status
- Submit formal claim appeals
- Submit predeterminations
More Information: Refer to the CIR page in our Provider Tools section of our website for more information and for the instructive CIR user guide to help you submit claim inquiries online.
Not registered for Availity? Sign up online today, at no cost at Availity.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 BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors and the products and services they offer.