Claim Encounter Reconciliation Application (CERA) via Availity® Provider Portal
The Availity Claims Encounter Reconciliation Application (CERA) helps providers manage and respond to BCBSNM if potential coding opportunities are identified -- based on claims data -- for members with on and off-exchange health plans. Providers may upload and submit the necessary medical documentation to BCBSNM using CERA in the Claims & Payments menu through the Availity Portal.
- To receive and respond to these potential coding opportunities electronically, you must be registered with Availity .
- To enable this feature, administrators must log into Availity and select My Providers | Enrollments Center and then select Claim Encounter Reconciliation Application (CERA) Setup and enter the required data.
For additional details, refer to the Claim Encounter Reconciliation Application (CERA) tip sheet .
If you need further assistance, you may contact Availity Client Services at 800-282-4548.
At this time, electronic medical record request and submission process through CERA are only available for quality and risk adjustment submissions, and are not available for medical record requests resulting from utilization review activities or the claims adjudication process. We anticipate offering additional capabilities throughout 2018.
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 independent 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.