RealMed

How RealMed Works

The RealMed process is as follows:

1. Member arrives for appointment and presents BCBSNC identification card.
2. Entering the patient’s ID number into the RealMed online application starts the process by instantly displaying the member’s demographic information on the provider’s office desktop. At this point, the status of the member as an active BCBSNC member is confirmed.
3. After being seen by the doctor, the check-out staff enters the patient’s ICD–9 and CPT codes into the HCFA 1500 claim format that is populated from the demographic information obtained from BCBSNC. In this manner, the data submitted by your office matches the data in the BCBSNC system, enhancing the first pass acceptance rate for claims.
4. The HCFA 1500 form is submitted to BCBSNC from your office through the RealMed network. A series of edit checks verifies that the claim is complete and clean, again raising the acceptance rate on first pass for your claims by BCBSNC. When errors are found in a claim, your staff has the ability to correct and resubmit claims on the spot - not days after the initial encounter with our member.
5. Messaging is sent to your staff from BCBSNC via RealMed, detailing the action taken on the claim. For those claims that adjudicate instantaneously, your office receives an electronic copy of the Explanation of Benefits (EOB), which matches those that are currently sent to members by BCBSNC. From this document, you have the ability to verify any member liability amounts (co-payment, deductible or co-insurance) and then collect those amounts from the patient before they leave the office.
6. The payment due to you from BCBSNC is processed on the next scheduled claims payment date following the adjudication notice that is sent to you.
7. The encounter has the ability to be closed before the member leaves your office — not days and weeks after the service is delivered.