This section provides a quick introduction to filing claims with BCBSIL. For additional information, including Timely Filing Requirements, Coordination of Benefits (COB), Medicare Crossover process and more, please refer to the BCBSIL Provider Manual.
You or your billing agent will need to utilize a third-party claims clearinghouse vendor such as Availity® Essentials to submit electronic Professional and Institutional claims (ANSI 837P and 837I transactions) to BCBSIL. For vendor options and information, refer to the Electronic Commerce page.
- Advantages include greater security and accuracy of data, along with faster processing and payment.
- Claims may be submitted one-at-a-time by entering information directly into an online claim form on the vendor portal; or batch claims may be submitted via your Practice Management System (check with your software vendor to ensure compatibility).
- Electronic reports are generated and sent automatically to confirm receipt and identify any errors that need to be rectified prior to adjudication and payment.
Please refer to the following websites for assistance with proper completion of paper claim forms:
- For CMS-1500 (Professional) claims, visit National Uniform Claim Committee (NUCC)
- For UB-04 (Institutional) claims, visit National Uniform Billing Committee (NUBC)
Electronic claim submission is preferred, as noted above. If necessary, commercial paper claims may be submitted to this address: BCBSIL, P.O. Box 660603, Dallas, TX, 75266-0603.
Government Programs Claims
Electronic claim submission is preferred, as noted above. If necessary, government programs paper claims may be submitted. There are different addresses for Blue Cross Community Health PlansSM, Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare AdvantageSM claims. Mail original claims to the appropriate address as noted below.
- Blue Cross Community Health Plans, c/o Provider Services, P.O. Box 3418, Scranton, PA 18505
- Blue Cross Community MMAI (Medicare-Medicaid Plan), c/o Provider Services, P.O. Box 3836, Scranton, PA 18505
- Blue Cross Medicare Advantage, c/o Provider Services, P.O. Box 3686, Scranton, PA 18505
- Do NOT submit duplicate claims.
- To confirm receipt and adjudication progress, check claim status.
Out-of-area (BlueCard®) Claim Process
BlueCard is a national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to obtain health care services while traveling or living in another BCBS Plan’s service area.
- The program allows you to submit claims for members from other BCBS Plans to the Illinois Plan.
- The three-character prefix preceding the member’s ID number is critical for proper routing of BlueCard claims.
- For complete details, refer to the BlueCard Program Manual.
Documentation and Coding Resources
High quality documentation and complete, accurate coding can help capture our members’ health status and promote continuity of care. We’ve put together some documentation and coding tip sheets for the following conditions:
- Asthma and Asthma-Associated Conditions
- Atrial Fibrillation
- Cancer and Cancer Related Treatment
- Chronic Kidney Disease
- Diabetes Mellitus
- Human Papillomavirus (HPV)
- Hypertension (High Blood Pressure)
- Major Depressive Disorder
- Mental, Behavioral and Neurodevelopmental Disorders
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.