Additional Enhancements to Claim Processing for ERS Plans Effective October 21, 2024

Effective October 21, 2024- Blue Cross and Blue Shield of Texas will further enhance claim processing for Employee Retirement System of Texas participants by adding more enhancements. Along with the current post-payment audits, BCBSTX will further enhance the facility billing and payment accuracy by adding pre-payment reviews.

This new process will help provide more accurate payment with less administrative complexity for ERS participants while providing ease of the billing/claims process.

These BCBSTX pre-payment reviews will be performed by CERIS, a subsidiary of CorVel Health Corporation. Currently, CERIS serves as a post-pay auditor on behalf of the ERS plan participants. In the new process, claims will be reviewed prior to payment. This would imply fewer requests for refund post-claim since discrepancies in the billing could have been found out in advance.

An FAQ regarding this new pre-pay review process will soon be available via the ERS Tools page with more details to assist ERS plan participants and their healthcare providers.

Additional documentation may be needed for this pre-pay review by CERIS to allow the claims to pass correctly, it means keeping a record of all the necessary documentation on the part of the providers. Furthermore, providers must send these documents directly to CERIS at the address shown on the request and not to BCBSTX.

CERIS is a third-party contractor and is not an affiliate of BCBSTX. BCBSTX does not endorse the services or products of CERIS or any other third-party vendor.

BCBSTX will release more detailed information about these enhancements on their official website. So, keep an eye out and contact your service representative for more clarity. For additional support with navigating these changes, Capline is here to assist you every step of the way.

 


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