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Medicare Advantage: New Claim Status Tool via Availity® Provider Portal

November 6, 2019

This notice applies to providers rendering services for the following Blue Cross and Blue Shield of New Mexico (BCBSNM) members:

  • Blue Cross Medicare Advantage HMOSM
  • Blue Cross Medicare Advantage PPOSM

As of Oct. 31, 2019, a new and improved Availity Claim Status tool is available for providers to verify status online for the above-referenced member. This Claim Status tool is found in the Claims & Payment menu in the Availity portal and allows providers to search for claims by member ID or specific claim number.

The claim status results are real-time and provide more detailed information than the HIPAA-standard 277 claim status transaction. In addition, this new claim status option returns the following details:

  • patient and provider data submitted on claims
  • in-network and out-of-network patient liability breakdown
  • billing and rendering provider name and NPI
  • check number, check date and payee name
  • other carrier payment amount
  • ineligible reason codes and associated descriptions

Webinar Training
Providers are encouraged to register for an upcoming training to learn how to efficiently verify claim status using this new online capability. To register for a session, simply click on the date and time below.

Resources Coming Soon
For additional instructions, watch for the new Government Programs: Claim Status Tool tip sheet that will soon publish in the Provider Tools section of our Provider website. As a reminder, you must be registered with Availity to utilize the Claim Status tool. For registration information, visit Availity Learn more about third-party links, or contact Availity Client Services at 800-282-4548.

If you have additional questions, contact our Provider Education Consultants.

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 Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.