![]() 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.Availity Electronic Batch (EBR) Response Reports.Certified Mail Receipt (only if accompanied by TDI mail log).The claim review process for a specific claim will be considered complete following your receipt of the 2nd 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:.If your clam has been overturned after reviewing, your payment/PCS will serve as your notification.If your claim has been maintained after review, you will receive a written notification of the claim review determination.BCBSTX will complete the second claim review within 45 days following the receipt of your request for a second claim review. ![]() If the claim review determination is not satisfactory to you, you may request a second claim review. ![]() If your claim has been overturned after reviewing your payment/PCS will serve as your notification.If your claim has been maintained after review, you will receive a 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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