Aug. 22, 2019
Aug. 22, 2019
Effective Aug. 26, 2019, Out-of-Network Line Level Detail Available in CRT
Providers can view out-of-network patient responsibility in the service line details when using the Claim Research Tool (CRT) in the Availity Portal. This enhancement will help providers identify if the patient liability was applied to the out-of-network co-payment, coinsurance, and/or deductible.
Effective Sept. 23, 2019, Cotiviti, INC. Rationale and Additional Action(s) Coming to CRT
Cotiviti Code Audit Rationale enhancements:
The CRT will be enhanced to offer greater specificity for Cotiviti (formerly known as Verscend) claim denials. Once implemented, providers will see the Cotiviti code-auditing logic descriptions for finalized claims. These expanded claim details will be available for claims finalized Aug. 26, 2019 and after.
Additional Action(s) enhancements:
Providers will see additional action(s) that will provide instruction for specific denials for finalized claims. These instructions will help providers understand what further action may be needed as a result of how the initial claim processed.
For additional information, refer to the CRT tip sheet in the Tools section on our website at bcbsmt.com/provider. As a reminder, you must be registered with Availity to utilize the CRT. For registration information, visit availity.com, or contact Availity Client Services at 800-282-4548.
Stay Informed! Continue to watch for future News & Updates announcements and helpful resources.
If you have additional questions about these enhancements, you may contact the Provider Education Consultants at PECS@bcbsmt.com.
Cotiviti, INC. is an independent company that provides medical claims administration for BCBSMT. Cotiviti is solely responsible for the products and services that it provides. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Cotiviti and Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.