Coding Opportunities Available Using CERA On Availity^®

Maintaining current and comprehensive diagnosis information for Blue Cross and Blue Shield of Texas (BCBSTX) members is imperative. BCBSTX utilizes multiple sources of data to identify conditions that a member had in the past, or may currently have, which have not been documented such as a diagnosis code on a claim during the current calendar year. In turn, BCBSTX often reaches out to providers to close these potential coding opportunities.

BCBSTX is working to make it easier for you to serve members with on and off marketplace health plans who are subject to quality and risk adjustment. Providers can now electronically respond to potential coding gaps and determine treatment opportunities with the Claim Encounter Reconciliation Application (CERA) through the Availity Portal.

This new, easy-to-navigate feature helps improve quality of care and risk adjustment by:

• Providing a more efficient alternative to mailing or faxing medical records
• Reducing delays associated with paper submissions
• Lessening in-person visits to retrieve medical records

Mailing and faxing medical records remain options for providers when responding to requests for quality and risk adjustment purposes. Providers who are not Availity users will continue to receive these requests by mail, fax or in-person visits. If you are not a registered Availity user, you can complete the guided online registration process at Availity.com  – at no charge.

LEARN MORE ABOUT CERA

• Check out this Getting Started Guide for CERA   and our CERA Tip Sheet for quick reference and navigational assistance
• With an Availity login, you may view the CERA – Training Demo  to understand the setup process and get started working with the tool
• With an Availity login, you may view this on-demand webinar: Claim Encounter Reconciliation Application (CERA) Recording  for additional learning

If you have any questions, contact Availity Client Services at 800-282-4548.

Availity users gain access to many useful tools and resources as well as new payer-provider business solutions. For example, with Availity providers can complete a wide range of electronic transactions for BCBSTX patients, such as verifying patient eligibility and benefits, checking claim status, processing a prior authorization, as well as using CERA to evaluate treatment opportunities for quality and risk adjustment purposes.

Currently, the electronic medical record request and submission process through CERA is only available for quality and risk adjustment submissions, and are not available for medical record requests resulting from utilization review activities or the claims adjudication process. We anticipate offering additional capabilities throughout 2018.

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 any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.