Provider portal pointers

This is an article ongoing series of tips and tricks designed to help you do your job more efficiently by getting the most out of the applications and tools available on our provider portal.

Claims status inquiry process

The claims status inquiry process is designed to streamline access to insurance claim statuses, identify issues and dispute claims, when necessary.

Note: To conduct a claims status inquiry, administrators must first assign the user the Claims Status role using Manage My Team(s), as previously discussed on Page 9 of the May-June issue of BCN Provider News. Without this role, users will be unable to access the claims status inquiry tool within the portal.

The steps to conduct a claims status inquiry are as follows:

1. Log in to the provider portal at availity.com.**
2. For all lines of business, click on Claims & Payments on the menu bar and then click on Claim Status.



3. Select the appropriate Organization from the drop-down menu.



If the user is tied to only one organization, it will be selected automatically. Those with access to multiple organizations will see all options displayed alphabetically.


4. Select the appropriate Payer from the drop-down menu. For Michigan users, this is typically BCBS Michigan and Blue Care Network, which includes lines of business such as Blue Cross commercial, BCN commercial, BCN Advantage℠, Medicare Plus Blue℠, FEP^® (Federal Employee Program^®) and other Blue plans.



5. Users have two search options to choose from when looking into the status of a claim:
• Option 1: Member Search

  Claim searches are typically conducted using the Member ID (e.g., enrollee or contract number) and the Date of Service (DOS) that should not exceed three and half years in the past.



Hint: In cases where a patient appears multiple times due to coverage types or group changes, select the correct record carefully.

• Option 2: HIPAA Standard

  For patients classified under FEP (Federal Employee Program) or OOS (Out of State), users should bypass the member search option and use the HIPAA Standard tab.



Hint: For best search results, only enter data for required fields marked with an asterisk.

6. Users can click the Dispute Claim button for Blue Cross, BCN and Medicare Plus Blue claims (only) if they meet the following criteria:
• There is a clinical edit.
• Claims were submitted within the last 45 days.

Note: Appeals are based on EX codes, which differ for each line of business.

To access EX code lists for each line of business:

1. Log in to the provider portal at availity.com.**
2. Click on Payer Spaces on the menu bar, and then click on the BCBSM and BCN logo.
3. Click the Resources tab.
4. Click Secure Provider Resources (Blue Cross and BCN).
5. Click Codes and Criteria in the Billing and Claims tab.
6. Scroll down to the Clinical Editing section to view all available EX code lists.

Additional help is available

A short video demonstrating the claims status process is also available. To view the video, click the camera icon on the Claim Status page.

Help us help you

If you have a suggestion for a provider portal topic you would like to see in future issues of The Record or BCN Provider News, contact us at bcnprovidernews@bcbsm.com.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.