Key Resources for Providers

You can check the status of a claim in a few ways. Use online claim status tools available through your local BCBS company or preferred web vendor for real‑time updates. If you need to speak with an agent, have the claim number ready and contact your local BCBS company for details.

Claims may be denied for a few common reasons. Checking information before you submit a claim can help reduce denials.

Common reasons include:

1. Missing or incorrect information on the claim
2. Services that are not covered
3. Required approval was not received
4. Patient coverage was not active
5. The claim did not meet clinical requirements
6. The claim was sent to the wrong insurer
 

Claims should be completed accurately to help prevent delays. Make sure patient and provider information is entered correctly on the claim form.

Use standard medical billing codes, such as procedure and supply codes, that match the services provided. Using the correct codes can help claims process more smoothly and reduce follow‑up or rework.

Eligibility and benefits should be checked before each scheduled appointment. This includes confirming the patient’s coverage and any cost‑sharing, such as copayments or deductibles.

Use eligibility and benefits tools available through your local BCBS company or preferred web vendor to verify coverage.

Some services require prior authorization before care is provided. Providers are responsible for requesting authorization when it is required.

Be ready to share basic patient, provider, and service information, such as:

• Patient name and date of birth
• Diagnosis and planned service
• Date and place of service
• Provider information
• Procedure codes, if needed

Submit the prior authorization request through your local BCBS company or preferred utilization management vendor.