Estado del reclamo

Checking Online

After submitting a claim, you can check the status online to verify if your claim has been received, pended or finalized. You can also verify the descriptions for any claim denials.

You or your billing agent can obtain real-time results by checking claim status through the Availity® Essentials Claim Status tool. The Claim Status tool provides the equivalent of an Explanation of Benefits (EOB), including line-item breakdowns and detailed denial descriptions. All results are printable and can be used as a duplicate EOB for another insurance carrier when requested.

Vea nuestras  Claim Status tool user guide para ver más detalles.

Only registered Availity users can access the Claim Status tool. If you aren't registered, go to Availity Más información sobre enlaces de terceros and select "Get Started" to complete the guided online registration process, at no cost. If you don't have Availity access, you may obtain basic claim status online by completing a claim status request (276 transaction) via your preferred web vendor.

Reminder: Don’t Submit Duplicate Claims

If your claim did not process the way you anticipated, it is important that you do not submit a duplicate claim for the same patient. Duplicate claims typically result in additional denials.

Adjust a Claim via Telephone

For commercial claims, if you have additional questions or need to request a claim adjustment, a document control number (claim number) is required when calling via our Interactive Voice Response (IVR) automated phone system to speak with an agent. To access our IVR system, call 888-349-3706. The system is available Monday through Friday, 5 a.m. to 10:30 p.m., MT, and Saturday, 5 a.m. to 5 p.m., MT. For additional details, refer to the Claims Caller Guide.

For government programs claims, if you don’t have online access through a vendor, you may call the below customer service phone number to check claim status or make an adjustment:

  • Blue Cross Community Centennial claims – call 800-693-0663
  • Medicare Advantage claims – call 877-774-8592

Preguntas

Email our Provider Education Consultants. Be sure to include your name, direct contact information, tax ID or billing NPI.

Related Resources:

Availity es una marca registrada de Availity, LLC, una compañía aparte que opera una red de información de salud para prestar servicios de intercambio de información electrónica a profesionales médicos. Availity presta servicios administrativos a BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.