If you do not have a contract with us, claims for certain services may be eligible for payment review under the No Surprises Act (NSA). Participating providers can contact your local Network Management office if you have any questions concerning the process for claim reviews. Mail the completed Claim Review form, along with any attachments, to the appropriate address indicated on the form. Primary carrier's EOB indicating claim was filed with the primary carrier within the timely filing deadline.Documentation from BCBSTX requesting additional information.Documentation from BCBSTX indicating claim was incomplete.Above documentation indicating that the claim was filed with the wrong division of Blue Cross and Blue Shield of Texas.You have 180 days from the date of discovery of. rEDI-link Blue Claim Acceptance Response Report If you have individual, group or self-funded non-ERISA group coverage, youre eligible under the state process.Certified Mail Receipt (only if accompanied by TDI mail log) Within 180 days following the check date/date of the BCBSTX-Explanation of Payment (EOP), or the date of the BCBSTX Provider Claims Summary (PCS).The claim review process for a specific claim will be considered complete following your receipt of the second claim review determination.įor those claims which are being reviewed for timely filing, BCBSTX will accept the following documentation as acceptable proof of timely filing: BCBSTX will complete the second claim review within 30 days following the receipt of your request for a second claim review.The second claim review must be requested within 15 days following your receipt of the first claim review determination. If the claim review determination is not satisfactory to you, you may request a second claim review. You will receive written notification of the claim review determination.BCBSTX will complete the first claim review within 45 days following the receipt of your request for a first claim review.
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