With your input in mind, Wellmark Blue Cross and Blue Shield enhanced its claims inquiry online tool to now include iCAP script and rationale narratives.

This additional information allows you to personally research why a claim was denied or payment changed because of iCAP processing. This time-saving feature means you no longer need to call Provider Service to have the script and rationale narrative read to you.

How this works

• Go to the "Claim Lines" header on the Claim Summary Information screen.
• In the table under the "Message" column, look for claims with a denial code starting with "I."
• Click on the message number starting with "I."
• Then, you will see the claim message information that includes the script and rationale.

Prior to this enhancement, you only received a high-level description such as: "Payment adjusted because information submitted doesn’t support this level of service." You’ll continue to receive this description in addition to the script and rationale.

Please note that if the claim is adjusted, only the last positive adjustment will be displayed in the tool. This is how the tool works today.

Here’s an example of the e script and rationale:

Self-serve for your convenience

Although Wellmark takes pride in having an excellent Provider Service staff, call volumes sometimes require you to be put on hold. You are encouraged to take full advantage of this convenient enhancement to get the information you need about your claims easily, more quickly, and on your time.   We’re pleased to announce that access to this information is now available 24/7. 

Electronic provider claims remittance coming

Providing you with the iCAP script and rationale is the start of several improvements to Wellmark’s web tools. This fall, you will also be able to access your provider claims remittance (PCRs) online. Watch for more information about the launch of this exciting enhancement.