Wednesday, February 1, 2017

Claim not on file denial

Having problems locating a claim you submitted to First Coast Service Options (First Coast)?

Claim not on file inquiry

There are steps you can take to make sure your claim was received by First Coast.

1. Before contacting customer service, check claim status.

• Reminder: The interactive voice response system (IVR) and customer service access the same claims system database. If the IVR has no record of a claim, customer service will also have no record.

2. Electronic claims

If you have not received an acknowledgement, you may have received a reject notification. If you have received a reject notification, the batch of claims you submitted contains an error that must be corrected.

3. Paper claims

If you are submitting the claims through the paper process, please allow sufficient time for us to receive, scan, and enter claims into the system. This process could take up to seven business days.

4. If the claim is not on file and still within the timely filing limits, resubmit the claim.

Enrollee not eligible on DOS Claim will deny if the client is not eligible during dates of service billed.

Check enrollee eligibility status through MediCall to verify eligibility on the date of service being rendered. If the enrollee is not eligible no payment will be received from Virginia Medicaid. If upon verification you find that the client is now eligible on that date of service resubmit the claim.

Enrollee is covered by private insurance, refer to third party information of this R/A

Our system indicates that there is a primary carrier, which needs to be billed prior to Medicaid. This carrier is now listed on your remittance advice under the claims information for that particular client. Please refer to this other coverage information which should be billed as primary.

*NOTE: If the client states there is no other coverage then they will need to contact their case worker at the Department of Social Services to have this information corrected


Checking Claim Status

You should receive a response from BCBSTX within 30 business days of receipt of a claim. If the claim contains all required information, BCBSTX enters the claim into BCBSTX’s claims system for processing and sends you a Remittance Advice (RA) or Claims Disposition Notice (CDN) at the time the claim is finalized.

Claim Status Online

You can confirm BCBSTX’s receipt of your claim through the Availity online tool at Using Availity, you can also view claims status and payment information.

IVR Claim Status

You can also confirm that BCBSTX received your claim through our Interactive Voice Response (IVR). Call the BCBSTX Customer Care Center (CCC) at 888-292-4487. CCC hours are Monday - Friday, 7 a.m. to 6 p.m. (Central Time), except certain holidays.

Claim Follow-Up/Resubmission

You can initiate follow-up action to determine claim status if there has been no response from BCBSTX to a submitted claim after 30 business days from the date the claim was submitted.

To follow up on a claim, you should:

Check or the IVR for disposition of the claim. Please note that the IVR accepts either your billing National Provider Identifier (NPI) or your federal Tax Identification Number (TIN) for Provider identification. Should the system not accept your billing NPI or Federal TIN, the system will route your call to a Customer Care Center representative who will help you with your query. For purposes of assisting you, we may ask you for your TIN.

Contact the Customer Care Center (CCC)

Provide a copy of the original claim submission and all supporting documentation (such as records and reports) that you deem pertinent or that has been requested by BCBSTX to:
Blue Cross and Blue Shield of Texas

Attn: Claims
P.O. Box 684787
Austin, TX 78768-4787
Reviewing Batch Status Reports (EDI Claims Only)

If you submitted your claim electronically, you should receive and confirm the contents of BCBSTX Batch Status Reports from your electronic vendor/clearinghouse and correct any errors. Errors must be promptly corrected and resubmitted (electronically) to prevent denials due to untimely filing.

Questions about Claim Status and Follow-Up

BCBSTX’s Customer Care Center (CCC) is available to answer any questions and provide further instructions regarding claim follow-up. A CCC representative can:

Research the status of claims.
Advise you of necessary follow-up action, if any.

Claim Returned for Additional Information

BCBSTX sends a request for additional or corrected information to you when the claim cannot be processed due to incomplete, missing or incorrect information in the original claim submission.

The request for information includes a form that allows you to return the requested information in an easy-to-follow format. We call this a mailback form. This form must be returned with the requested information in order to process the claim.

BCBSTX also may request additional information retroactively for a claim that has already been paid. The mailback form also is used for these situations.
Time Frame for Returning Requested Information

If you receive a request from BCBSTX for additional information, you must provide this information within 21 calendar days from the date of the request or your claim may be denied.

How to Submit Requested Additional Information

To resubmit additional or corrected information on a claim, you should send: A copy of the mailback form requesting more information. Any and all supporting documentation (such as records and reports) that you deem pertinent or that has been requested by BCBSTX.

A copy of the original, corrected CMS-1500 or CMS-1450 (UB-04) claim form.

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