Medicare Plus Blue clinical editing portal available through Availity

To improve provider experience, Blue Cross Blue Shield of Michigan is making a clinical editing portal available to health care providers that provides additional details when a when a Medicare Plus Blue℠ claim goes through clinical editing. Health care providers can use the portal to enter a new hypothetical claim or look up an existing claim for Medicare Plus Blue members whose member ID begins with X3L. This functionality is expected to expand to more members in the future.

Claims entered in the portal aren’t submitted into the claims system. The portal provides a way to test different claim scenarios and identify potential edits without submitting a live claim. When looking up an existing claim, unique identifying information is required, such as provider ID and either a claim ID or a patient ID and date of service).

To access the clinical editing portal, follow these steps:

1. Log in to the Availity website at availity.com.**
2. Click on Payer Spaces on the Availity menu bar.
3. Click on the Blue Cross and BCN logo.
4. Click on CES Portal on the Applications tab.

When using the portal, providers must input claims data, whether hypothetical or existing. Once the claim has been analyzed, the line-by-line edits are returned and displayed in the user interface.

This is a simulation tool that doesn’t guarantee approval or reimbursement of a claim. Other edits may apply when a claim is submitted and processed.

A user guide is available on the provider training site and is also accessible from the provider portal. Go to the Applications tab of the BCBSM/BCN Payer Space on Availity and click on Provider Training Site. Once you are on the site, use the keywords “CES” to search for the user guide. If you need assistance navigating the provider training site, email ProviderTraining@bcbsm.com.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.