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Atypical Providers May Need to Resubmit Claims

Posted July 25, 2017

Blue Cross and Blue Shield of Illinois (BCBSIL) is required by the Department of Healthcare and Family Services (HFS) to coordinate covered services for providers, including those out-of-state, who are enrolled through the HFS Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system. Each week, BCBSIL receives a file from HFS with details on provider registration through IMPACT. BCBSIL uses this file to verify provider registration prior to processing claims for Blue Cross Community Integrated Care Program (ICP)SM, Blue Cross Community Family Health PlanSM (FHP) and Affordable Care Act (ACA) members. Claims and encounters submitted by a terminated or non-registered provider will be rejected for reimbursement by HFS and BCBSIL. 

BCBSIL recently made changes to its systems, which may have led to incorrectly denied claims for some providers who had their information updated in the IMPACT system. The providers who were impacted may have experienced incorrect denials for NPI not registered. 

Atypical providers -- defined as a provider that is registered with IMPACT without an NPI -- are required to submit claims without the presence of an NPI on their claim. BCBSIL recently experienced issues processing claims for Atypical providers billing via paper and Availity™. A system fix was put in place on July 14, 2017. Atypical providers that experienced this denial in error should ensure their registration has been updated with IMPACT and then resubmit claims via paper or Availity. 

Atypical providers billing through the Availity Web portal, may experience issues with the NPI populating automatically when utilizing the “Express Entry – Billing Provider” drop-down selection upon submission. Atypical providers impacted by this should correct their provider information in the Availity Express Entry by selecting “this provider is not required to have an NPI.” Once this is corrected in Availity, Atypcial providers may submit these claims electronically via Availity, without the NPI requirement.  

BCBSIL apologizes for any inconvenience this may have caused and appreciates your participation in the BCBSIL Medicaid network. 

For assistance with the Availity Express Entry set-up, providers may contact a BCBSIL Provider Education Consultant at PECS@bcbsil.com.   

As a reminder, beginning Feb. 1, 2017, HFS began terminating Medicaid providers who enrolled with HFS prior to Feb. 1, 2012, and have not yet revalidated their information through the IMPACT system.  For more information, refer to the previous News & Updates “HFS Terminates Medicaid Providers Not Revalidated in IMPACT” article published on Feb. 13, 2017. 

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.