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Real-Time Claim Adjudication

RTCA delivers a whole new consumer experience by combining patient eligibility, member financial responsibility, real-time claim adjudication and real-time response. RTCA enhances CareCalc by allowing real-time claim submission and completes the member/provider transaction. This capability can simplify reconciliation and streamline a provider practice’s administrative duties. There are no costs or fees. The RTCA option is only available after completing a successful CareCalc inquiry. CareCalc and RTCA are currently available to select BlueChoice, BlueOptions, BlueCare, BlueMedicare HMO, BlueMedicare PPO, GoBlue plans and Miami-Dade Blue plans. Also some other blue's plans are eligible. 

Professional Real-Time Claim Adjudication 

With RTCA, you can seamlessly convert from a CareCalc member responsibility determination straight to the submission of a real-time claim, saving you the time and inconvenience of completing lengthy paperwork. Neither you nor the member will pay additional costs or fees when you use these helpful tools.  
Information to consider when submitting a RTCA transaction:
  • RTCA can be used for professional services rendered in the office (11), home (12), outpatient (22), ASC (24), urgent care (20), emergency room (23), independent clinic (49), and independent lab (81).
  • It is only available after completing a successful CareCalc inquiry. If the "Submit" button is not active, the transaction is not eligible for RTCA.
  • RTCA is available for PA provider groups and has a section that allows you to enter rendering provider information when it differs from the billing provider.
  • Claims cannot be changed through RTCA. You can submit a corrected claim electronically in Availity.
RTCA Messages
The following actions should be taken when RTCA summary indicates the below messages:
  • "Your claim has been successfully processed. Please review the information below. If you have questions about the responses, please contact your payer."
    • RTCA users will receive this message when BCBSF has successfully received and processed their claim. You can either verify claim status on Availity or CRT or can await their paper or electronic remittance advice. 
  • "Your claim has been submitted successfully. However, this claim requires additional review. You will be notified if additional information is required" or "BCBSF has processed your claim".
    • RTCA users will receive this message to acknowledge that BCBSF has received their claim submission. Whenever possible, BCBSF will return a claim number enabling providers to check the status on Availity or CRT. In some instances these claims may require further review. You will be contacted if additional information is needed.

 

1/18/2012
The Manual is not intended to be a complete statement of all BCBSF polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and BCBSF or Health Options the terms of such agreement(s) shall govern.

The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and Florida Blue or Health Options the terms of such agreement(s) shall govern.

Refer to the References section to view all applicable copyrights, registered trademarks, service marks, and/or references. Acronyms are also defined in the References section.

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