These complimentary online applications can be used to accomplish tasks and gain information. Some of the tools require registration through a third-party vendor portal, as noted—see our E-Commerce Connections menu for vendor registration details.
It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.
To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity’s Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information. Learn more
Behavioral health professionals and physicians may obtain benefits information for Blue Cross and Blue Shield members using the Availity® Eligibility and Benefits (E&B) tool. This free online tool can provide you with copayment, coinsurance, deductible, and other important information. Learn more
Find facilities recognized for expertise in bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery, and transplants on the Blue Distinction website. Learn more
The Availity® CareCost Estimator (CCE) tool is an online member liability estimator that can help professional providers estimate a patient’s potential out-of-pocket costs in real-time for office and outpatient services provided to BCBSIL members. Learn more
The CareProfile tool uses claim-based information to provide you with a consolidated view of a patient’s health care history at the point of care. This electronic health record can help you identify gaps in care, missed prescription refills and possible drug interactions, and other “clinical flags” and treatment opportunities. Learn more
Our Claim Inquiry Resolution (CIR) tool is available via a tab in our Electronic Refund Management (eRM) system. By providing a method for online assistance with specific inquiries on finalized claims, the CIR tool can help save your staff time by reducing the need for phone calls and written correspondence. Learn more
The Claim Research Tool—CRT—offers enhanced, real-time claim status functionality to help you manage and resolve your BCBSIL claims. To gain access to the CRT, you must be registered with Availity® Learn more
Clear Claim Connection—C3—is a free online reference tool that mirrors the logic behind BCBSIL’s code-auditing software*. You can use C3 to help determine how coding combinations on a particular claim may be evaluated during the adjudication process. Learn more
CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of the Blue Cross and Blue Shield of Illinois (BCBSIL) pharmacy PA program. Learn more
The Electronic Refund Management (eRM) tool is designed to help simplify overpayment reconciliation and related processes. Learn more
Our automated preauthorization tool—iExchange—supports direct submission and provides online approval of benefits for inpatient admissions, as well as and select outpatient, pharmacy and behavioral health services 24 hours a day, seven days a week – with the exception of every third Sunday of the month when the system will be unavailable from 11 a.m. to 3 p.m. (CT). iExchange is accessible to physicians, professional providers and facilities contracted with BCBSIL. Learn more
The Member Liability Estimator (MLE) tool can provide you with a real-time, estimated member share amount at the time of service, while the patient is still in your facility, prior to claim submission. Learn more
The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by Blue Cross and Blue Shield of Illinois (BCBSIL) in the 835 Electronic Remittance Advice (ERA). Learn more
OptiNet is an online assessment tool developed by American Imaging Management® (AIM®) to collect modality-specific data from imaging providers. Blue Cross and Blue Shield of Illinois (BCBSIL) is pleased to introduce this tool as an enhancement to our Radiology Quality Initiative (RQI) program, which AIM administers for BCBSIL. Learn more