Claim Inquiry Resolution – High-Dollar, Pre-Pay Reviews

Claim Inquiry Resolution (CIR) is available via a tab in our Electronic Refund Management (eRM) system. The CIR function provides a method for inquiry submission related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) claims (Medical Records and/or Itemized Bills) handled by BCBSNM.

For additional details, refer to the CIR User Guide.

To gain access to the CIR function, you must be enrolled for eRM, which is accessed through our BCBSNM-branded Payer Spaces > Applications section via Availity® Essentials. CIR may not be accessed through our Customer Advocates on the phone.

Additional Resources:

All previous CIR inquiry options have transitioned to one single access point via the Availity Essentials Claim Status tool. To request a claim review online, refer to the links below to learn how to use the Dispute Claim or Message This Payer capabilities after performing a Claim Status search using the Member* and/or Claim Number tabs.

*Use the Member tab in the Availity Claim Status tool to search, view and submit an inquiry online for the most recently processed claim.

 

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 third party vendors and the products and services they offer.