Accessing the Claim Research Tool 2.
Getting Started 1.
The Claim Research Tool is the recommended method for providers to acquire status on claims processed
by Blue Cross and Blue Shield of Texas (BCBSTX).*
Organizations can improve their accounts receivable by utilizing this exclusive BCBSTX feature to check
status for local, federal and out-of-state claims. Results are available in real-time and provide the
equivalent of an Explanation of Benefits (EOB).
* To obtain status on claims not processed by BCBSTX, users should contact the appropriate claim processing entity directly (i.e., third party vendors, other carriers, etc.).
Note: Only registered users can access the Claim Research Tool.
Select Claims from top mega menu
Select Claim Research Tool (BCBS)
1
Contact your Availity account Administrator if Claim Research Tool (BCBS) is not listed in the Claims menu. Note:
December 2016
Availity™ Claim Research Tool
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of
the Blue Cross and Blue Shield Association
Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Ass ociation, an
association of independent Blue Cross and Blue Shield Plans.
Go to availity.com
Select Availity Portal Login or Register
Enter User ID and Password
Select Log in button
Note:
Claim status can be obtained using a Patient ID or 13-digit Claim Number. Claim Numbers are also
referred to as a Document Control Numbers (DCN). Both options are illustrated below.
Search by Patient ID
Select Patient ID from the Search
Option drop-down
2
Running a Transaction 3.
Instructions for running a transaction by claim number are included on page 3. Otherwise, proceed
to step 4.
The Claim Research Tool is an exclusive to BCBSTX offering. To check status on claims processed by other
payers, use Claim Status Inquiry.
BCBSTX
For the Express Entry Provider,
select the appropriate Billing (Type
2) NPI from the drop-down or enter the NPI manually
Complete these data fields:
• Patient ID (include the 3-letter alpha prefix before the
identification number)
• 6-character Group Number
• Service Period dates
Select Submit
Helpful Hints:
• Federal plans do not have an alpha prefix. The letter R should be typed as part of the Patient ID (i.e., R87654321).
Enter the Group Number as 0FEPTX.
• Out-of-state plans may contain more than three letters (e.g., WMWAN1234567). Enter the Group Number as
123456.
The Payer field will automatically
default to BCBSTX.
Note:
999999999999X
BCBSTX
Search by Claim Number (DCN)
Key the 13-digit alpha numeric
claim number in the Claim # (DCN)
field
Select Submit
Helpful Hint:
• To search for an adjusted or reprocessed claim, key the corresponding 2-digit suffix in addition to the 13-digit claim
number (i.e., 999999999999X01).
• If copying and pasting the claim number from another document or program, be sure to delete any additional spaces.
3
Select Claim Number (DCN) from
the Search Option drop-down
Search Results 4.
To view detailed claim status for a specific date of service, select the corresponding Claim Number
Note: The information returned will include original, adjusted, withdrawn and replacement claims.
BCBSTX
For the Express Entry Provider,
select the appropriate Billing
(Type 2) NPI from the drop-down or enter the NPI manually
1234567890
4
Returned information includes:
• Claim Number
• Received Date
• Processed Date
• Claim Status
• Billed Amount
• Paid Amount
• Coinsurance
• Co-Pay / Deductible Amount
• Ineligible Amount(s)
• Check/EFT/Voucher
• Check Date
• Payee Name
• Health Care Account Amount
• Other Carrier / Medicare Paid Amount
• Patient Share Amount (total)
• Billing Provider ID / Name
• Rendering Provider ID / Name
• Line Item Breakdown
Service Dates
Revenue / Procedure Code
Diagnosis
Ineligible Reason Code / Amount
Copay / Coinsurance / Deductible
breakdown
Modifier
Unit, Time, or Mile
• Ineligible Reason Code Descriptions
Running a Transaction 5.
$109.23
Online Transaction Tips
How to avoid a Claim Not Found Response
5
Institutional Claims
• Paid amounts reflected on the Detail Search Results screen indicates reimbursem*nts applied
per individual provider contracts (e.g., Per Diem, DRG, etc.).
• Itemized payments listed in the line item breakdown will equal the total paid amounts indicated
on Provider Claim Summaries (PCSs) and Electronic Remittance Advices (ERAs).
If…
• All line items are not displayed on the Detail Search Results screen, click the More Results link.
• The Detail Search Results screen prints are distorted, adjust the Page Orientation (in Print Settings) to landscape.
• The check number is not present on a finalized claim (see below), please allow additional time. The system reflects check information based on the payment schedule of the provider.
• The Type 2 Billing NPI must matches the NPI submitted on claim.
• Enter the three letter alpha prefix prior to the member’s identification number in the Patient ID
field.
• For local policies, the group number matches what was submitted on the claim.
• The date span entered as the Service Period includes the actual date(s) of service.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to
medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsem*nt, representations or warranties regarding any
products or services offered by independent third party vendors such as Availity. If you have any questions about the products or services offered by such
vendors, you should contact the vendor(s) directly.
Check / EFT / Voucher:
Check Date: 06/09/2016
Payee Name: Holmes Clinic
Questions? Email the Provider Education Consultants at [emailprotected]
Be sure to include your name, direct contact information, Tax ID or Billing NPI.
mailto:[emailprotected]
