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New! Online Member Liability Estimator

November 16, 2011

The new Availity® CareCost EstimatorSM (CCE), developed jointly with Availity, is a member liability estimator* (MLE) tool. The CCE will review the available information submitted: primary diagnosis, procedures performed, available benefits and contractual allowances. Then, the CCE will calculate an estimated out-of-pocket cost in real-time for office and outpatient services provided to BCBSOK members.**

Using this free online tool can help provide your practice with greater transparency regarding a member’s potential out-of-pocket costs, giving you the option to decide if you would like to collect the estimated member’s share at the point of service. The CCE tool is available only to registered Availity users and may be accessed only via the Availity Web portal. This MLE function is not available via BCBSOK Customer Advocates on the phone or through our automated Interactive Voice Response (IVR) phone system.

Remember—the CCE is exactly that—an “estimator.” This means that the CCE tool provides an estimate of the member’s liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. The CCE does not provide preauthorization or any guarantee of payment. If the actual dollar amount collected from the member is greater than the amount owed, once the claim has been processed, the provider will be obligated to promptly refund the overpayment to the member. In addition, please check your Provider Agreement before collecting estimated co-insurance amounts up-front. Professional Agreements do not allow collection of co-insurance until the Claim Summary has been received.

An Availity CareCost Estimator Tip Sheet is available in the Education and Reference Center of the BCBSOK Provider website. View the CareCost Estimator Tip Sheet for complete details on exceptions and other limitations of this new tool. Registered users can also attend free Availity webinars to learn about the CCE tool and other Availity applications. For a current schedule of webinar offerings, just click on “Free Training” from any page after logging on to the Availity portal.

To register with Availity, access the free CCE tool and learn about other options, visit www.availity.com. You may also contact Availity Client Services at (800) AVAILITY (282-4548) for assistance.

*The Estimator is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, benefits, limitations and exclusions and the terms of the member’s certificate of coverage in effect on the date services are rendered. Accumulated amounts, such as deductibles, may change as additional claims may have been processed after the estimate was provided.

**See the CCE Tip Sheet for a brief list of exceptions.

Availity is a registered trademark of Availity, L.L.C., an independent, third-party vendor. Availity is solely responsible for all of its products and services, including the CareCost Estimator.