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Changes to the Claim Review Form

December 19, 2016

The paper Claim Review Form for Blue Cross and Blue Shield New Mexico (BCBSNM) has been updated to simplify the process for providers when submitting written claim inquiries.

The most efficient way to request a claim review for specific inquiries is electronically through the Claim Inquiry Resolution tool, which is accessible through the Availity™ Web portal. For providers who need to submit claim review requests via paper, the previous process involved using one universal Claim Review Form. As a result, this form was utilized for several different reasons, such as paper corrected claims, requested medical records, claim check denials, or even basic claim reviews.

BCBSNM is streamlining the paper claim review process to help facilitate more accurate processing of incoming requests. As of Jan. 1, 2017, written claim inquiries must be submitted on one of the specific provider Claim Review Forms listed below. Each Claim Review Form must include the BCBSNM claim number (the Document Control Number, or DCN), along with the key data elements specified on the forms. These forms are available now on our Provider website in the Education and Reference Center/Forms section, under Claims.

New Claim Review Forms

  • Additional Information Form
  • Claim Review Form
  • Corrected Claim Form

Online verification of online claim status is strongly encouraged prior to submitting claim review requests. The most effective way to determine claim status is electronically through your preferred Web vendor, or by using the Availity Claim Research Tool. Making use of electronic options allows retrieval of needed information in near real-time.

As indicated above, Availity users have access to the Claim Inquiry
Resolution
  tool, which delivers a method of online assistance for specific inquiries on finalized claims. This tool is designed to help save you time by reducing the amount of calls and written inquiries submitted.

To learn more about these and other electronic options, visit the Provider Tools section in our online Education and Reference Center. For personalized online training regarding electronic tools, contact our Provider Education Consultants at PECS@bcbsnm.com.

Availity is a trademark of Availity, L.L.C., 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 offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.