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Eligibility and Benefits
Before You Administer Treatment…
Follow these steps every time a BCBSIL member visits your office.
1. Ask for the Member’s ID Card
- Alpha prefixes and other information can change
- Make a copy to ensure you have the correct information on file
- Also ask to see a photo ID to help guard against medical identity theft
2. Check Eligibility and Benefits
- Use one of the “How to” methods below to verify participation and coverage details, according to the member’s benefit plan
- This includes confirmation of copays, coinsurance and deductibles
- When services may not be covered, you should notify the member that they may be billed directly
How to Check Eligibility and Benefits
Online
- Submit an electronic Eligibility & Benefits Inquiry (ANSI 270 transaction) to BCBSIL through your preferred online vendor portal
- Not yet registered with a third-party vendor? See our E-Commerce Connections menu for more information.
Telephone
- Contact our Provider Telecommunications Center (PTC) at (800) 972-8088*
- Our automated Interactive Voice Response (IVR) system is available Monday through Friday, 6 a.m. to 11:30 p.m., CT, and Saturday, 6 a.m. – 3 p.m., CT
- For IVR navigation tips, view the caller guides in our Education and Reference Center
*Exceptions:
- For out-of-area Blue Cross and Blue Shield members, call the BlueCard® Eligibility Line at (800) 676-BLUE (2583). Learn more about BlueCard
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For Federal Employee Program (FEP) member eligibility, call (800) 972-8382. To learn more about FEP, visit the Product Information section of the BCBSIL Provider Manual.
