News and Updates
Dec. 13, 2010 (Updated Feb. 4, 2011)
BCBSIL is now accepting applications from Acupuncture providers who would like to receive direct payments for covered services rendered to BCBSIL members.
Please note: Acupuncturists are not eligible to become participating PPO providers.
In order for us to establish direct payment arrangements, you must:
- Answer all questions on the Blue Shield application
- Have a valid Illinois or Indiana license for acupuncture
- Have a valid National Provider Identifier (NPI)
To request a Blue Shield application, call (312) 653-6555, or send an e-mail to: email@example.com. Please allow 45 days for processing from the time BCBSIL receives your completed application.
Dec. 30, 2010 (Updated Jan. 6, 2011)
This program applies only to members who receive behavioral health care benefits through Blue Cross and Blue Shield of Illinois (BCBSIL). Please check the member’s ID card for verification.
BCBSIL has made a change to its new Behavioral Health program effective Jan. 1, 2011. The preauthorization requirement has been eliminated for outpatient behavioral health visits, except as identified below.
The intent of the program is to help members access their behavioral health benefits, while also helping to improve coordination of care between medical and behavioral health care providers. The Behavioral Health program is designed to achieve the following objectives:
- Give members guidance regarding care options and available services based on their benefit plan;
- Help members identify network providers that best fit their care needs; and
- Identify co-existing medical and behavioral health conditions earlier.
Although preauthorization for outpatient behavioral health services is not required—except as listed below—outpatient behavioral health care management services will continue to be available on a voluntary basis. Members who wish to consult BCBSIL’s licensed behavioral health staff professionals when accessing behavioral health services may call the Mental Health/Substance Abuse number on the back of their member ID card for assistance.
Some outpatient behavioral health services will still require preauthorization. All outpatient electroconvulsive therapy (ECT), psychological testing, neuropsychological testing, partial hospital admissions and intensive outpatient programs require preauthorization before the initiation of services.
BCBSIL is committed to providing unrivaled customer service to members and collaborating with providers to ensure that members receive quality care that is consistent with professional standards.
Please see the link below for additional information. If you have further questions, contact your assigned Provider Network Consultant.
All behavioral health benefits are subject to the terms and conditions as listed in the member’s benefit plan.
Dec. 24, 2010
As of Jan. 1, 2011, two new Current Procedural Terminology (CPT®) codes for the administration of immunizations will become effective. The code descriptions are as follows:
Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component
Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure)
BCBSIL will recognize these newly adopted CPT codes as of Jan. 1, 2011. The initial vaccine administration will be reimbursed at the full allowance. Learn More
Current Procedural Terminology (CPT® ), copyright 2008, by the American Medical Association (AMA). CPT is a registered trademark of the AMA.
Nov. 12, 2010
In the October Blue Review , we announced the implementation of new code auditing software within the BCBSIL claim processing system. On or after March 21, 2011, BCBSIL will implement ClaimsXtenTM, a code auditing tool developed by McKesson Information Solutions, Inc.
In addition to mirroring the logic that is currently featured in the ClaimCheck® system, ClaimsXten will allow BCBSIL to expand claim processing with aggregate historical claims data. This will assist in adjudicating claims in a manner that is more efficient and cost-effective. With the implementation of ClaimsXten, BCBSIL will be better able to evaluate claims for global periods, as designated by the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule, in addition to reviewing multiple claims for a single date of service. Learn more
Nov. 8, 2010
New ID cards are being issued to Boeing Company Associates effective Jan. 1, 2011. Blue Cross and Blue Shield of Illinois (BCBSIL) is the new administrator for all Boeing employees nationwide, replacing Regence Blue Shield of Washington. Please remember these guidelines when servicing Boeing Company employees to help facilitate claim processing. Learn More
Oct. 15, 2010
We’re pleased to introduce the Availity® CareCost EstimatorSM (CCE)—our new online member liability estimator, which is available now to help professional providers improve billing accuracy and efficiency for BCBSIL member claims.
Developed jointly with Availity, the CCE tool analyzes BCBSIL members’* primary diagnoses, procedures, benefits and contractual allowances, then calculates the estimated out-of-pocket costs for their office and outpatient services in real-time.
Available free of charge to BCBSIL independently contracted providers who are registered with Availity, the CCE tool helps provide your practice with greater transparency regarding members’ out-of-pocket costs. It also gives professional providers the opportunity to collect the member’s share at the point of service. Learn more
Oct. 14, 2010
We are continuing to enhance efficiency of the self-service claim status menu options offered by our Interactive Voice Response (IVR) phone system. Beginning Oct. 18, 2010, you will have the option to speak to a Customer Advocate (CA) only after you obtain responses via the IVR at both of the following claim status levels:
- Overall status – check amount, paid date, etc.
- Line item detail (professional claims only) – allowable amounts, ineligible reason codes, etc.
These menu changes address the fact that there are limited reasons to speak with a CA after obtaining claim status information from the IVR. The IVR and CA quote from the same source: the BCBSIL claim system. By utilizing the automated IVR phone system for routine requests, you allow our CAs to dedicate more time to addressing and resolving claim inquiries beyond status quotes. Learn more
Sept. 30, 2010
Effective Sept. 1, 2010, Coram Specialty Infusion Services became the primary provider of immunoglobulin (Ig/IVIG) Therapy services for members in the Blue Cross and Blue Shield of Illinois (BCBSIL) PPO network.
If you currently have patients receiving Ig/IVIG Therapy services, Coram will be contacting your office to obtain orders and begin transitioning service from the patient’s current pharmacy provider, as deemed appropriate. Your patients are also being notified concurrently about the available transition by mail and via telephone. Learn more
Aug. 27, 2010
In June 2008, we published a complete listing of electronic claim edits that were implemented in support of an NPI-only claims processing environment. This document provided the three-digit error code along with a defining message indicating the severity level of the error and the resulting impact on the claim (“W” for Warning and “R” for Rejection).
An updated NPI-only Electronic Claim Submission Edits listing has been posted under E-Commerce Alerts in the Claims and Eligibility/Electronic Commerce section of our website. Please be advised that most of the edits/error listings that were formerly set at the Warning level will be set to Reject as of Sept. 6, 2010. Learn more
July 16, 2010
Beginning July 19, 2010, you will notice the following changes when you call Provider Telecommunications Center (PTC) to obtain basic claim status information via our automated Interactive Voice Response (IVR) phone system:
- If the IVR system identifies that your claim is pended (still being processed), and your claim is aged less than 21days, you will be advised that additional time is needed to process your claim.
- The system will remind you to utilize online claim status options, such as the Availity®’ Claim Research Tool (CRT), or other enhanced claim status tools offered by your preferred vendor portal.
- You will no longer have the option to speak with a Customer Advocate (CA) for claim status on pended claims, since those claims are still in process and additional information is not yet available via the IVR system or the CA. Learn more