Aug. 26, 2019
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. 21, 2019, Cotiviti Rational and Step-in-Action Coming to CRT
Cotiviti (formerly known as Verscend) enhancements:
The CRT will be enhanced to offer greater specificity for Cotiviti 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.Step-in-Action enhancements:
Providers will see next step messaging that will provide instruction for specific denials for finalized claims. Those instructions will help providers understand what further action may be needed as a result of how the initial claim processed.
CRT Reminders:
- 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 0FEPOK.
- 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 Provider Tools section on our website at bcbsok.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@bcbsok.com.
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 BCBSOK. BCBSOK 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.