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Electronic Claim Adjustment Request Changes

Audience: All Providers

We would like to make you aware of upcoming changes to the electronic claim adjustment request process.

Effective June 1, 2021, Excellus BlueCross BlueShield will no longer accept electronic adjustment requests for claims that have been finalized and additional information has been requested.

This includes claim adjustment requests submitted for an In Process, Paid or Denied claim listed with:

  • Explanation codes K27, K28, K31, K32, K34, K35, K37, K38 (OrthoNetTM codes), or
  • Explanation codes Z01, Z12, Z13, Z19, Z20, Z26, Z31 and Z52 (Coding Validation codes)

These clinical editing (CE) denials will be returned with the message, "Supporting documentation. Medical notes/report".

Note: For electronic claims, the 277CA will report claim status codes: 294:297 (Supporting documentation. Medical notes/report)

Please follow the CE dispute process by submitting a CE form, corrected claim (if applicable) and medical records for the date of service in question electronically using the provider web portal, or by mailing to:

Attn: Clinical Editing Coordinator
P.O. Box 21146
Eagan, MN 55121

Please share this information with all practice locations and billing offices. If you have any questions related to these changes, contact Customer Care at 1-800-920-8889.

Thank you for the quality of care and service that you provide to our members.

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