Effective November 21, 2008 through May 31, 2011, Medical Doctors/Doctors of Osteopath (MDs/DOs) may file a post-service External Review to resolve disputes related to the application of coding and payment rules and methodology related to ClaimCheck, bundling, modifiers, etc. Blue Cross and Blue Shield of ­­­­­­­­­­­­­­­­­Texas’ Internal Appeal process must be exhausted before an External Review will be considered. External Reviews are conducted by an Independent Review Organization, MES Solutions.

An External Review can be submitted via web, fax or mail. The guidelines for submitting an External Review and the applicable fees can be found on the MES Solutions’ Web site at

https://secure.mesgroup.com/Secure/bdrp/ProvBillDispInstr.aspx?MNBD=B 

posted 11/2008