Blue Cross and Blue Shield of Alabama providers have several options available for accessing member eligibility and benefits, claim status and remittances. Providers can access this information through their electronic Practice Management (e-PM) software, ProviderAccess found on our website, www.bcbsal.com, and the Interactive Voice Response (IVR).
Providers are encouraged to take advantage of our toll-free provider customer service line. When calling the toll-free provider customer service line, be prepared to let the representative know what information you have already accessed. For example, if after checking claim status through ProviderAccess you need additional assistance with a denied claim, provide the date of service, the remittance date and the claim rejection code/definition. If you contact Customer Service before researching the claim, you will be asked to access one of the resources given above.
Blue Cross and Blue Shield of Alabama no longer mails ProviderFacts and Special Bulletin publications. These publications as well as other provider news and updates are now made available on our website, www.bcbsal.com. An e-mail notification is sent to alert providers when new articles and important updates are posted on our website. Please be sure we have a current e-mail address on file for your practice. To add or update an e-mail address for provider notifications, please complete the Provider E-mail Update Form.
The “Provider Resources” section on our website provides access to many useful forms as well as links to our provider publications and manuals.
General Helpful Information
- Please do not give your National Provider Identifier (NPI), Tax ID number or provider location ID to a member to call Provider Customer Service. This telephone number is dedicated to providers. Members should call the telephone number listed on the back of their identification cards if they need assistance from Customer Service.
- Effective dates of coverage can be verified through ProviderAccess and your e-PM software or through the IVR. Benefits and eligibility for a specific date can be verified by entering the date in the “Service Date” field. You can also determine primary/secondary contract status for a specific date.
- Verify member benefits and eligibility for out-of-state Blue Cross and Blue Shield contracts through ProviderAccess.
- For an explanation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) rejection codes found on your remittance, refer to www.wpc-edi.com.
- When a non-covered service is rejected on a remittance, it is usually due to benefit restrictions, the procedure or the diagnosis. Always check the member’s benefits prior to performing a service. Also, make sure the correct procedure code(s) and diagnosis code(s) are indicated on the claim.
- When the audit report rejection “service rendered after coverage terminated” or “patient not covered on contract” is returned, but the eligibility and benefits electronic response states the patient is active for the date of service filed, it is probably due to a retroactive update on the member’s contract. Check the claims system for updates prior to calling Provider Customer Service.
- If a claim from a remittance is not returned electronically from Blue Cross, check eligibility and benefits information for contract updates. A “corrected contract number” may be displayed on the remittance. The claim may have been filed with one contract number, but processed with another.
- Remittance copies can be obtained electronically from the Blue Cross website through ProviderAccess, from your e-PM software and/or the IVR at 1-800-648-9807. If the remittance is more than six months old, the IVR 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. Remittance copies are not available through Customer Service.
- Precertification requirement information is available through ProviderAccess in the eligibility and benefits information.
- A predetermination is a preauthorization to determine medical necessity and is procedure specific rather than contract specific.
Last Updated June 2010