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Claim Dispute Form Filing for Government Programs

Posted May 14, 2018

Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM contracted providers can now file written claim status inquiries and claim disputes using a new Provider Claims Inquiry or Dispute Request form.

  • A claim dispute is a request for review and reconsideration of a claim nonpayment or payment amount. Claim disputes should be filed with the specific claim numbers that need to be reconsidered for payment with the explanation for payment re-evaluation. Claim disputes are not intended for reconsideration of any pre-service determinations.
  • A claim status inquiry is a request for additional information on the resolution of a submitted claim that is not intended to result in a change of the claim payment amount. A claim status inquiry can be made with electronic data interchange (EDI) routing numbers or other applicable information that would help Blue Cross and Blue Shield of Illinois locate the claim if claim number(s) are not available.

Complete the Provider Claims Inquiry or Dispute Request form and either mail or fax it to:

Mail
Blue Cross Community Health Plans
C/O Provider Services
P.O. Box 4168
Scranton, PA 18505

Fax
855-322-0717

NOTE: All pre-service determination appeals, which are requests for reconsideration on a denial for services that have not yet been rendered to the member, should continue to go to:

Mail
Blue Cross Community Health Plans
Attn: Grievance and Appeals Unit
P.O. Box 27838
Albuquerque, NM 87125-9705

Fax
866-643-7069