Claim Information without a human

[williamportor]

Hello - If a biller needs detailed information on claims that did not pay, and the insurance companies (beloved) automated phone system does not allow one to speak with a live human being about it, how does one get this information? I submitted several claims to BCBS of Texas, most have paid, but several did not. All the EOB said was "A contract co insurance has been taken" That sounds fine, except BCBS of Texas is the only insurance this patient has, and my provider/client wants to know what to do about this....NOW, and I don't know what to tell him. Any ideas? 

[kristin]

1. Can you get access to detailed claim information by registering for BCBS/TX website, or through using Availity?
2. Can you get to a human by using the claim adjustment prompt, and giving the claim number? This always gets me to a human with BCBS of Illinois.
3. Is the provider contracted with their local BCBS, and is that who the claim was submitted through? If so, and the denial is saying that a co-insurance was taken, what is listed as patient responsibility?

[PMRNC]

I'd also check to see if those are ERISA claims and could the patient be the one receiving payment?  ERISA trumps provider contracts and standard AOB is not enough for provider to receive compensation under ERISA.