The Claim Reconsideration tool allows providers to electronically submit claim reconsiderations for situational finalized claim denials (including BlueCard® out-of-area claims), using Availity® Essentials 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 begin using the new method for claim reconsideration requests now, as the Claim Inquiry Resolution (CIR) tool will be modified to only accommodate certain claim scenarios. The claim reconsideration option should be used to inquire on a previously processed claim.
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.
For additional details, refer to the instructional Claim Reconsideration Request User Guide. Also see the Claim Status Tool User Guide on the Claim Status Tool page for help obtaining enhanced claim status online.
Questions on electronic options?
Email our Provider Education Consultants for assistance. Be sure to include your contact information, Tax ID, and Billing NPI numbers.
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.