Blue Cross and Blue Shield of New Mexico (BCBSNM) is excited to announce a new and convenient electronic capability to submit claim reconsiderations for situational finalized claim denials (including BlueCard® out-of-area claims), using Availity’s Dispute capability anchored off the enhanced Claim Status tool. This method of inquiry submission is preferred over faxed/mailed claim disputes to BCBSNM, as it allows providers to upload supporting documentation and monitor the status all online.
A Claim Reconsideration is a request to review and/or reevaluate a claim that has been finalized.
Please note: This electronic option is not currently available for Medicare Advantage claims.
We encourage you to start utilizing the new claim reconsiderations process now, as the Claim Inquiry Resolution (CIR) tool will be retired later in 2023. Using this new online offering allows the following:
- status management
- upload of supporting documentation with submission
- view and print confirmation and decision
- generates a Dashboard view of claim reconsideration request activity
- view uploaded documents after attached to the request*
*Note: Uploaded attachments may take minutes to hours before they are viewable in the request.
Steps to submit claim reconsideration requests online:
- Log into Availity Essentials
- Select Claims & Payments from the navigation menu, then choose Claim Status
- Search and locate the claim using the Member or Claim Number options
- On the Claim Status results page, select Dispute Claim (if offered and applicable)
- Select Reconsideration as the Dispute Reason
- Complete the Dispute Request form
- Upload supporting documentation
- Review and submit your claim reconsideration request
For assistance with obtaining enhanced claim status online, refer to the Claim Status Tool user guide.
Availity Administrators must assign users the Claim Status role in Availity Essentials to ensure users can access and submit electronic claim reconsiderations online. If your provider organization is not yet registered with Availity, you can sign up today at Availity, at no charge. For registration assistance contact Availity Client Services at 800-282-4548.
For More Information
Refer to the Claim Reconsideration User Guide in the Provider Tools section of our website. If you need further education or assistance, contact our Provider Education Consultant.
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 BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.