Spring 2009

Real-Time Claim Adjudication tool enhanced; also now available to PA groups

CareCalc^® Real-Time Claim Adjudication (RTCA), the first tool in the health care industry to combine patient financial responsibility with real-time claim adjudication, has been enhanced with a new section that enables users to enter rendering provider information when it differs from the billing provider. Also new, messages that match those displayed on the provider’s Remittance Advice are designed to help providers better understand what claim processing occurred.

Introduced by Blue Cross and Blue Shield of Florida (BCBSF) to individual professional providers last year, RTCA is available for professional association (PA) provider groups as of February.

BCBSF, in partnership with the Availity^®1 Health Information Network, developed CareCalc in 2006 to enable providers to determine estimated member cost. The tool reproduces how the claim would process, including claim edits, based upon information available at the time of the inquiry. RTCA enhances CareCalc by allowing real-time claim submission and completing the member/provider transaction. As a result, providers now can perform a CareCalc member responsibility determination, collect the appropriate member responsibility, immediately submit the claim to BCBSF and print a claim summary, all in about two minutes.

Both CareCalc and RTCA are offered exclusively by BCBSF and accessed through Availity. To access the CareCalc link, first complete an Eligibility and Benefits transaction. The CareCalc button will display on the Eligibility and Benefits Summary and Details pages only if CareCalc is available for that BCBSF member’s plan.

If you do not have access to CareCalc or have not used it, obtaining access is easy. Simply complete the CareCalc Access Registration Form available on our website, www.bcbsfl.com, in the Physicians & Providers section, select Tools & Resources, then Forms. Once you complete the form, fax it to (904) 357-6993. A BCBSF representative will contact you when your registration is completed.