Availity Provider Portal Claim Submission and the Claim Status Tool

Blue Cross Blue Shield of North Dakota (BCBSND) would like to remind providers of the functionality our Availity Provider Portal has to offer. This months’ Availity tips are claim submission and the claim status tool using the Availity Provider Portal.

Claim Submission Reminders:
Data entry is important to ensure a clean claim is entering the Availity system. Quite often claims deny due to simple keying errors or missed fields. Double checking the data entered in the required claim submission fields, will help ensure a clean claim has entered the system.
 
Incorrect data or missing information can cause the claim to deny due to:

  • Incorrect Member UMI
  • Incorrect date of service
  • Incorrect dollar amount
  • Incorrect NPI, Provider or Rendering Provider information
  • Incorrect diagnosis, CPT or HCPCS
  • Missing the appropriate modifier

Claim Status Tool Reminders:
The claim status tool allows providers to search for the status of a claim and review details for claims that the payer has adjudicated. Providers can also review the remittance reviewer for payment information or correct a claim. Providers can use this tool even if you didn't submit your claims through Availity.
 
**Note: When performing a claim status search always use the same Billing NPI used on the claim, or you will not find the matching claim in the system. If you want multiple claims to return a status for a specific member, use a date span.

The claim status tool allows the provider to review:

  • Status of the claim (Color coded):
    • Green- finalized and paid by the payer
    • Yellow- pending with payer
    • Red- finalized and denied by the payer
  • Billed/Paid amount
  • Process date
  • Correct or void a claim to create a new claim

Accessing the remittance review from the claim status tool allows the provider to review the payment information on their own, saving the provider time from having to make a phone call to our Provider Contact Center.

  • Remittance viewer provides payment information
  • Provider can search by the following options:
    • Search by check/EFT or claim
    • Provider NPI
    • Select date range
    • Use filter options

As a BCBSND Provider, you may be already registered with the Availity Provider Portal, if not we encourage you to register at Portal Registration.  Whether you are a current user or new to Availity, we encourage providers to take advantage of on-demand Availity Portal Training.

To access the Availity Training center as shown below:

  • Log in to your Availity Account and click on “Payer Spaces” located on the navigation bar
  • Access “Resources”
  • Enroll in “Claim Status” or “EDI Claims Submission” on-demand training

For more information on how to register, and the variety of tools that are available to you, contact Availity.

  • Contact Client Services at 1-800-282-4548
    • Monday through Friday, 8 a.m. to 7:30 p.m. EST 

Availity website: https://www.availity.com