Providers can utilize Dispute Claim to electronically submit appeal requests on commercial members for specific clinical claim denials using Availity® Essentials.
When applicable, Dispute Claim is available after obtaining Availity Claim Status results using the Member ID and/or Claim Number tab.
A Clinical Appeal is a request to change an adverse determination for care or services when a claim is denied based on lack of medical necessity, or when services are determined to be experimental, investigational or cosmetic.
Using this online offering allows the following:
- status management of the appeal
- upload clinical medical records with submission
- view and print confirmation and decision letter
- generates dashboard view of appeal-related activity to monitor status
For navigational assistance, refer to the Electronic Clinical Claim Appeal User Guide. Also see the Claim Status Tool User Guide on the Claim Status Tool page for help obtaining enhanced claim status online.
Providers not registered with Availity, can sign up today, via Availity, at no charge. For registration assistance, contact Availity Client Services at 1-800-282-4548.
Note: Refer to the claim Explanation of Benefits for additional information on appeal rights and submission options.
This information is not applicable to Medicare Advantage, Texas Medicaid or BlueCard® (out-of-area) claims.
Questions on electronic options?
Email our Provider Education Consultants. Be sure to include your contact information, Tax ID and/or Billing NPI numbers.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.