Claim Inquiry Resolution is available within our in our Electronic Refund Management (eRM) system. The CIR function provides a method for inquiry submission related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) claims (Medical Records and/or Itemized Bills) handled by BCBSTX.
For additional details, refer to the CIR User Guide.
To gain access to the CIR function, you must be enrolled for eRM, which is accessed through our BCBSTX-branded Payer Spaces > Applications section via Availity® Essentials. CIR may not be accessed through our Customer Advocates on the phone.
Additional Resources:
Previous CIR inquiry options have transitioned to one single access point via the Availity Essentials Claim Status tool. To request a claim review online, refer to the links below to learn how to use the Dispute Claim or Message This Payer capabilities after performing a Claim Status search using the Member* and/or Claim Number tabs.
Note: The below online options are not currently available for Medicare Advantage or Texas Medicaid claims. Additionally, Message This Payer and Clinical Claim Appeal Requests are not applicable to BlueCard (out-of-area) claims.
- Claim Reconsideration Requests (Dispute Claim)
- Message This Payer
- Clinical Claim Appeal Requests (Dispute Claim)
*Use the Member tab in the Availity Claim Status tool to search, view and submit an inquiry online for the most recently processed claim.
You may verify if additional information is needed by using the Message This Payer feature (if applicable) or contacting Provider Customer Service. For additional information requested via mail, follow the instructions provided in the letter. If you do not have Availity access or an electronic option for a claim review, use the appropriate form found in the Forms section of our website.
Providers who are not yet registered with Availity, can sign up today at Availity, at no charge. If you need registration assistance, contact Availity Client Services at 800-282-4548.
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.