Itemized Bills Required for BlueCard® Claims Over $200k

Posted September 26, 2019

Beginning Jan. 1, 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) will require facilities to submit an itemized bill for any BlueCard member billed at or more than $200,000 for inpatient care. The Blue Cross and Blue Shield Association requires an itemized bill to complete your claim. An itemized bill helps ensure accurate claim payment and reduces the need to submit more information after claims are paid.

What has changed?
The claim amount requiring itemization is changing from the $250,000 threshold in 2019, to $200,000.

How to Submit Itemized Bills
You may submit itemized bills electronically using the Claim Inquiry Resolution tool. Be sure to include the corresponding claim number.

More Information
Refer to the Clinical Payment and Coding Policy on our provider website for more information. If you have any questions, please contact your BCBSIL Provider Network Consultant.

What is BlueCard?
BlueCard is a national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to obtain health care services while traveling or living in another BCBS Plan's service area. BlueCard members usually have a suitcase logo* on their identification card.

As a reminder, it is important to check member eligibility and benefits through Availity® or your preferred vendor web portal prior to every scheduled appointment. For BlueCard members, you may also call BlueCard Eligibility at 800-676-BLUE (2583). Providers must also ask to see the member's ID card for current information and a photo ID to help guard against medical identity theft.

* Medicaid and State Children’s Health Insurance Plan members will not have a suitcase logo.

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