Electronic Clinical Claim Appeal Requests

Dispute Claim allows providers to electronically submit appeal requests for specific clinical claim denials through Availity Essentials. When applicable, Dispute Claim is available after obtaining Availity Claim Status results using the Member ID and/or Claim Number tab.

Clinical Appeal is a request to change an adverse determination for care or services when a claim is denied based on lack of medical necessity, or when services are determined to be experimental, investigational or cosmetic.

Using this online offering allows the following:

  • status management of the appeal
  • upload clinical medical records with submission
  • view and print confirmation and decision letter
  • generates dashboard view of appeal-related activity to monitor status

For navigational assistance, refer to the Electronic Clinical Claim Appeal Request User Guide. Also see the Claim Status Tool User Guide for help with obtaining enhanced claim status online.

Providers not yet registered with Availity can sign up today via Availity Learn more about third-party links, at no charge. For registration assistance, contact Availity Client Services at 800-282-4548.

Note: Refer to the Explanation of Benefits for additional information on appeal rights and submission options. 

This information is ONLY applicable to Federal Employee Program® (FEP®) and New Mexico Medicaid claims.

Questions on electronic options?

Email our Provider Education Consultants. Be sure to include your contact information, Tax ID and/or Billing NPI numbers.

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.