Blue Review
A newsletter for Medicaid providers

January 2019

How to Keep the Cash Flowing: Submitting Corrected and Duplicate Claims

At Blue Cross and Blue Shield of Texas (BCBSTX), we understand there are times when you must submit a corrected claim. A corrected claim is a replacement of a previously submitted claim for reasons such as changes or corrections to charges, clinical or procedure codes, dates of service, member information, etc.

The electronic submission of corrected claims reduces paperwork, eliminates printing and mailing expenses, and improves claim payment accuracy. Review instructions to submit claims electronically via the Availity® Provider Portal. Note: an electronic form must be completed for Medicaid claims. The form is available on availity.com through the Payer Spaces/Resources tab.

Your submissions should be completed through the Availity Provider Portal – there is no need to fax the form or inform us of your resubmission.

Paper Submissions
The process to submit a corrected claim on paper is:

  • Stamp “Corrected Claim” on top of your CMS-1500 or CMS-1450 forms.
  • Mail the corrected claim to:

Blue Cross and Blue Shield of Texas
P.O. Box 51422
Amarillo, TX 79159-1422

A Note About Submitting Duplicate Claims
Per your provider agreement, BCBSTX will make a payment for services within 30 days of when we receive a clean claim, regardless of submission format (electronic or paper). A duplicate claim is a claim submitted by a provider for the same service delivered to an individual on a specified date of service, which was included in a previously submitted claim. This does not include corrected claims.

Before you resubmit a claim because you have not received a payment or a response regarding the claim – please log in to availity.com and use the Availity Claim Research Tool. The Claim Research Tool features an Explanation of Benefits (EOB), including line-item breakdowns and detailed denial descriptions. All results are printable and can be used as a duplicate EOB for another insurance carrier when requested. Contact the Availity Customer Service Center at 1-800-282-4548, Monday through Thursday from 7 a.m. to 5 p.m. and Friday from 7 a.m. to 4 p.m. CT for any questions about your claims submissions.

Keep in mind:

  • By resubmitting a claim for a second time, we must conduct additional investigative steps, which lengthens claim processing time.
  • If you resubmit a duplicate claim, it may result in an additional denial.
  • The member will receive multiple EOBs for the same service, which often results in a call to your office.
  • The majority of claims submitted to BCBSTX are processed within 30 days.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third-party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.