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Predetermination of Benefits: Electronic Request Reminders and Paper Process Changes

Posted September 29, 2017

As a reminder, predetermination of benefits requests may be submitted electronically to Blue Cross and Blue Shield of Illinois (BCBSIL) through iExchange®, our online benefit preauthorization and predetermination of benefits tool. Providers also may upload attachments, check status and obtain online approval information via iExchange. This online tool is available to all physicians, professional providers and facilities contracted with BCBSIL. iExchange may be accessed directly or through the Availity™ Web portal and is designed to help save you time by reducing the amount of calls and written inquiries submitted to BCBSIL. 

If you need to submit a paper predetermination of benefits request to BCBSIL, it is important to send the pertinent medical documentation using our Predetermination Request Form. Beginning Dec. 1, 2017, paper predetermination requests must be submitted using the Predetermination Request Form. Please note that, as of Jan. 1, 2018, paper requests that are received at BCBSIL without the Predetermination Request Form will be returned to the submitting provider, along with instructions to resend the request using the appropriate form.  

Checking eligibility and benefits is always an important first step, prior to submitting predetermination of benefits and other pre-service requests. Eligibility and benefits requests may be submitted electronically through Availity, or your preferred Web vendor. Predetermination of benefits requests are not a substitute for the eligibility and benefits process.  

To learn more about iExchange and other electronic options, visit the Provider Tools section. For personalized online training regarding electronic tools, contact our Provider Education Consultants at PECS@bcbsil.com

Note: This information does not apply to HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, Blue Cross Community OptionsSM (MMAI, ICP, FHP and MLTSS), Blue Cross Medicare Advantage HMOSM or Blue Cross Medicare Advantage PPOSM members.  

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized 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 back of 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. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.