Close Patient Care/Diagnosis Gaps with New Informational Claim Process

Blue Cross and Blue Shield of Alabama now offers a new informational claim process in which you have the option to submit an informational claim through ProviderAccesseClaims to report previously closed patient care/diagnosis gaps. The informational claim is for reporting purposes only.

Effective March 6, 2017, the option to dispute an item on a patient’s Patient Health Snapshot (PHS) has been removed and replaced with the “Guide to Closing Patient Gaps” and “Blue Advantage Guide to Closing Patient Gaps” to assist with closing patient gaps. These documents provide you with an in-depth look at scenarios that may apply to your patients when addressing gaps and submitting an informational claim.

These documents are located on our provider website, AlabamaBlue.com/providers. Log in and type “Guide to Closing Patient Gaps” in the search box. It will populate both versions of the guide for you.

Note: The absence of an appropriate “history of code for a resolved condition” is the only scenario in which a dispute can still be filed. This option is available for Blue Advantage patients only. Refer to the “Blue Advantage Guide to Closing Patient Gaps” for more details.