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Availity® Essentials
Register with Availity at no cost to conduct secure online transactions, such as checking eligibility and benefits, submitting prior authorization requests handled by Blue Cross and Blue Shield of Illinois, obtaining claim status, viewing provider claim summaries and more. Learn more, register or log on: Availity Essentials
Availity Client Services: 800-282-4548
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Behavioral Health Program
BCBSIL manages BH services for all commercial non-HMO members
who have BH benefits through group and retail products. Similar BH programs are implemented across product lines but may differ by product.View behavioral health program contacts and other information
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BlueCard Eligibility® Line
Call for out-of-state Blue Cross and Blue Shield member eligibility and benefits 800-676-2583
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Carelon Medical Benefits Management
For prior authorization requests handled by Carelon for members with commercial non-HMO and Blue Cross Community Health PlansSM. Carelon Provider Portal (available 24x7)
Carelon Contact Center: 866-455-8415
- Commercial hours: Monday through Friday, 6 a.m. to 6 p.m. CT; and 9 a.m. to noon CT on weekends and holidays
- Medicaid (BCCHPSM) hours: Monday through Friday, 7 a.m. to 7 p.m. CT
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Dental Benefits Customer Service (Commercial only)
Dental Benefits Customer Service (Commercial only) 800-367-6401 (Monday through Friday, 8 a.m. to 6 p.m. CT.)
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Electronic Commerce Services
Contact us if you have questions about electronic transactions that can’t be answered by your clearinghouse or software vendor. Email our Electronic Commerce Services team.
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Evicore healthcare
For prior authorization requests handled by Evicore for members with Blue Cross Medicare Advantage (PPO)SM. Evicore Web Portal (available 24x7)
855-252-1117 (Monday through Friday, 7 a.m. to 7 p.m. CT, except holidays)
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Federal Employee Program®
Verify eligibility and benefits and/or check claim status for FEP® members FEP customer service: 800-972-8382
FEP behavioral health services: 877-783-1385 -
Fee Schedule Requests
For providers who are already participating in these networks: Preferred Provider Option (PPO), Blue Choice PPOSM, Blue Choice PreferredSM, Blue Choice SelectSM and Blue High Performance Network®. View fee schedule forms and instructions.
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Fraud Reporting
Report concerns of potential fraud 24x7, online or by phone. All inquiries to our Special Investigations Department are confidential, and you may remain anonymous. Call the Fraud Hotline: 800-543-0867
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Medical Management
If you have questions on a prior authorization request handled by BCBSIL, use our automated phone system to contact our Medical Management department. Commercial (non-HMO): 800-572-3089
Medicare Advantage (PPO): 877-774-8592
Medicaid (BCCHP): 877-860-2837 -
Medicare Advantage
Medicare Advantage Provider Customer Service
Individual plan phone 877-774-8592 Group plan phone 877-299-1008 Medicare Advantage Claims Payments and Appeals
Electronic claims (preferred) Availity® Essentials or your preferred vendor
Electronic payer ID 66006
Paper claims Blue Cross Medicare Advantage
c/o Provider Services
PO Box 3686
Scranton, PA 18505Medicare Advantage Claims Payments and Appeals
Register with Availity at no cost to conduct secure online transactions, such as checking eligibility and benefits, submitting prior authorization requests handled by Blue Cross and Blue Shield of Illinois, obtaining claim status, viewing provider claim summaries and more. Learn more, register or log on: Availity Essentials
Availity Client Services: 800-282-4548
Prospective and Concurrent Medical Appeals
Who can request a medical appeal: Member, member's authorized representative, contracted providers or noncontracted providers
Standard appeals fax 1-800-419-2009 Expedited appeals fax 1-800-338-2227 Mailing address Blue Cross Medicare Advantage
c/o Appeals Department
PO Box 663099
Dallas, TX 7526Retrospective Medical Appeals
Who can request a retrospective medical appeal: Member, member's authorized representative or noncontracted providers
Standard appeals fax 1-800-419-2009 Mailing address Blue Cross Medicare Advantage
c/o Appeals Department
PO Box 663099
Dallas, TX 75266Provider Disputes
Who can request a provider dispute: contracted providers
Standard claims dispute fax 1-855-674-9192 Mailing address
Blue Cross Medicare Advantage
c/o Provider Disputes
PO Box 4555
Scranton, PA 18505Provider Claims Disputes
Who can request a provider claims dispute: Contracted and noncontracted providers
Standard claims dispute fax 1-855-674-9192 Mailing address Blue Cross Medicare Advantage
Attn: Provider Claims Disputes
PO Box 4555
Scranton, PA 18505Grievances
Who can file a grievance: Member or member’s authorized representative
Grievance fax 1-855-674-9189 Mailing address Blue Cross Medicare Advantage
Attn: Grievances
PO Box 4288
Scranton, PA 18505Medicare Advantage Utilization Management
Availity Authorizations & Referrals Electronically submit prior authorization requests
Prior authorization requirements for Medicare Advantage EviCore healthcare prior authorization Prior authorization and out-of-network referrals Phone: 877-774-8592
Fax: 855-874-4711 -
Pharmacy Programs
As our pharmacy benefit manager, Prime Therapeutics® administers
our pharmacy program for eligible members.View pharmacy programs information -
Provider Customer Service
Provider Customer Service – Commercial
If you don’t have online access, call our Provider Telecommunications Center to use our automated phone system for eligibility and benefits, other self-service requests and claims inquiries. 800-972-8088 (Monday through Friday, 8 a.m. to 11:30 p.m. CT; and Saturday, 6 a.m. to 3:30 p.m. CT) Provider Customer Service – Government Programs
Use these numbers for claims and other inquiries for our members with Blue Cross Medicare AdvantageSM and Medicaid plans. Medicare Advantage (PPO and HMO): 877-774-8592
Medicaid (BCCHP): 877-860-2837 -
Provider Demographic Updates
If you need to change your existing demographic information (legal name, National Provider Identifier, Tax ID number, physical address, phone or fax number, email, hours of operation, etc.). View instructions on how to verify and update your information
Complete our online Demographic Change Form
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Provider Learning Opportunities
Free training is available for providers, billing services, clinical and administrative staff who are new or already contracted with BCBSIL. View options and register for webinars and workshops
For customized training, contact our Provider Education Consultant Specialist team
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Provider Relations Representatives
Our provider relations representatives can offer information on products and initiatives for BCBSIL, how to use online tools, provider education opportunities and personalized office visits. View provider relations representative assignments and contact information
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Provider Roster Requests
To request a roster for your practice, include your group name, NPI and Tax ID. Email our Provider Roster Requests team.
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.
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. Carelon Medical Benefits Management is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Evicore healthcare (Evicore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.