Cotiviti Denial Rationale and Additional Action(s) Now Available in the Claim Research Tool
In the August 2019 News and Updates notice we announced new and exciting functionality coming to the Claim Research Tool (CRT) on the Availity portal. Listed below are the CRT enhancements implemented by Blue Cross and Blue Shield of New Mexico (BCBSNM) to improve your online claim status experience. As a reminder, the CRT is not currently available for government programs (Medicare Advantage) claims.
Cotiviti, INC. (formerly known as Verscend) Code Audit Denial Rationale:
The CRT now returns Cotiviti claim denial logic for finalized claims processed on or after Aug. 26, 2019. This enhancement offers greater claim processing specificity, allowing you to view expanded denial descriptions and rationale.
The CRT response now provides Additional Action(s) for specific ineligible reason codes on finalized claim denials. This information will help you understand what further step(s) may be taken for certain claim denial scenarios.
Providers are encouraged to register for an upcoming training to learn about these new capabilities. To register for a session, simply click on the date and time below.
- Oct. 9, 2019 – 1 to 1:30 p.m.
- Oct. 11, 2019 – 10 a.m. to 10:30 a.m.
- Oct. 15, 2019 – 9 to 9:30 a.m.
- Oct. 17, 2019 – 2 p.m. to 2:30 p.m.
For additional information, refer to the CRT tip sheet in the Provider Tools section on our website at bcbsnm.com/provider. As a reminder, you must be registered with Availity to utilize the CRT. To register with Availity, go to availity.com and complete the online guided process.
If you have additional questions, 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).