General Helpful Information

Many forms are available on the Blue Cross web site, www.bcbsal.com. After entering the site and choosing the “I am a Provider” option, select “Forms” under the “Provider Resources” section.

Note: The “Provider Resources” section includes other general information such as Hot Topics, provider publications and manuals.

When a claim rejects as a non-covered service, it is usually due to benefit restrictions, the type service or the diagnosis. It is always a good idea to review the benefits on the contract, and the diagnosis on the claim. Call Customer Service for incorrect rejections.

When a claim is rejected stating service rendered after coverage terminated but the system shows the patient active, it is probably due to a retroactive update on the contract. Often by the time the remittance is reviewed, the claims have already been corrected. It is a good idea to check the claims system for updates prior to calling Customer Service. It is appropriate to call when claims are not reprocessed. The same applies to claims rejected stating that the patient is not covered on the contract but the patient is listed as covered.

If a claim from a remittance is not showing in the Blue Cross system, it could be due to a prefix change. Check eligibility for contract updates. It is also a good idea to review the “Corrected Contract” information on the right side of the remittance. The claim may have been filed with one contract number, but processed with another.

Remittance copies are not available through Customer Service. They can be obtained electronically from the Blue Cross web site or vendor software, and from the voice response unit (VRU) at 1 800 648-9807. Note that if the remittance is more than six months old, the VRU will advise that there is no matching information. When this happens, wait a few seconds and additional options will be presented, including the option to request a copy of the remittance.

Last Updated March 2010