MLTSS Claims Rejected for Inactive Coverage

Posted July 12, 2017

Electronic claims submitted by providers for Blue Cross Community Managed Long Term Supports and ServicesSM (MLTSS) members for any dates of service between April 13, 2017, and May 23, 2017, may have rejected erroneously for inactive coverage. Specifically, these eligibility rejections affected MLTSS members who were originally enrolled for Blue Cross Community MMAI (Medicare-Medicaid Plan)SM coverage, but whose policies were transferred to MLTSS.

The above issue was resolved on May 24, 2017, and Blue Cross and Blue Shield of Illinois (BCBSIL) is processing those claims that were impacted by this issue. Impacted providers should not resubmit the rejected claims.

It should be noted that reprocessed claims will still be subject to all other terms and conditions of the member’s coverage, including eligibility, in effect on the date of service. If the patient was ineligible for coverage as an MLTSS member on the date of service, the claim will be denied. To verify active MLTSS coverage for a particular patient and date of service, conduct an electronic eligibility and benefits (270) inquiry through AvailityTM or your preferred vendor portal, using the payer option of “Blue Cross Community Options.”

We appreciate your patience and apologize for any inconvenience the above issue may have caused. 

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

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 offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.