New and Exciting Functionality Coming to the Claim Research Tool (CRT) via Availity® Provider Portal
Effective Aug. 26, 2019, Out-of-Network Line Level Detail Available in CRT
- Providers can view out-of-network patient responsibility in the service line details when using the Claim Research Tool (CRT) in the Availity Portal. This enhancement will help providers identify if the patient liability was applied to the out-of-network co-payment, coinsurance, and/or deductible.
Effective Sept. 23, 2019, Cotiviti, INC. Rationale and Additional Action(s) Coming to CRT
Cotiviti Code Audit Rationale enhancements:
The CRT will be enhanced to offer greater specificity for Cotiviti (formerly known as Verscend) claim denials. Once implemented, providers will see the Cotiviti code-auditing logic descriptions for finalized claims. These expanded claim details will be available for claims finalized Aug. 26, 2019 and after.
Additional Action(s) enhancements:
Providers will see additional action(s) that will provide instruction for specific denials for finalized claims. These instructions will help providers understand what further action may be needed as a result of how the initial claim processed.
- The CRT is not yet available for government programs (Medicare Advantage) claims.
- Locate duplicate claims, along with the original by performing a Patient ID search.
- When using the Patient ID search to locate Federal Employee Program® (FEP®) claims, utilize group number 0FEPNM.
- When using the Patient ID search to locate out-of-state member claims, utilize generic group number 123456.
- Claim adjustments are identified by two-digits suffix on the claim number. For example, claim number 123456789D10X00 indicates it is an original submission. Claims ending with suffix 01 indicate the claim has been adjusted once.
For additional information, refer to the CRT tip sheet in the Tools section on our website at bcbsnm.com/provider. As a reminder, you must be registered with Availity to utilize the CRT. For registration information, visit availity.com , or contact Availity Client Services at 800-282-4548.
Stay Informed! Continue to watch for future News & Updates announcements and helpful resources.
If you have additional questions about these enhancements, you may contact the Provider Education Consultants at PECS@bcbsnm.com.
Cotiviti, INC. is an independent company that provides medical claims administration for BCBSNM. Cotiviti is solely responsible for the products and services that it provides. 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 Cotiviti and Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.