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Code Audit Denial Rationale and Additional Action(s): New Claim Research Tool Functionality

Posted October 4, 2019

In the August 2019 News and Updates, we alerted you of new and exciting functionality coming to the Claim Research Tool (CRT) on the Availity® Provider Portal. We’re following up to confirm that the enhancements listed below have been implemented by Blue Cross and Blue Shield of Illinois (BCBSIL) to help improve your online claim status experience for commercial claims.*

  • Cotiviti, INC. (Cotiviti, formerly known as Verscend) Code Audit Denial Rationale – The CRT now returns Cotiviti claim denial logic for finalized claims processed on or after Aug. 26, 2019. This enhancement offers greater claim processing specificity, allowing you to view expanded denial descriptions and rationale.
  • Additional Action(s): – The CRT response now provides Additional Action(s) for specific ineligible reason codes on finalized claim denials. This information will help you determine what further step(s) may need to be taken for certain claim denial scenarios.

Sign Up for an Availity CRT Provider Training Webinar
We encourage you to join us for a free webinar to learn more about recent Availity CRT enhancements. To sign up for an online training session, simply click on your preferred date and time:

For additional information, refer to the CRT tip sheet in the Provider Tools section. As a reminder, you must be registered with Availity to use the CRT. To register with Availity, go to availity.com and complete the online guided process.  

If you have questions, contact the Provider Education Consultants at PECS@bcbsil.com.

*The CRT is not currently available for government programs (Medicare Advantage and Illinois Medicaid) claims.

Cotiviti, INC. is an independent company that provides medical claims administration for BCBSIL. Cotiviti is solely responsible for the products and services that it provides. 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 BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Cotiviti and Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s).