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New Electronic Commercial Claim Validation Edits, Effective April 1, 2020

Posted February 28, 2020

As of April 1, 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions).* These claim edits will be applied to claims during the pre-adjudication process to help increase efficiencies and to comply with Medicare data reporting requirements.

Providers submitting these claims electronically on or after April 1, 2020, may see new edit messages on the response files from their practice management system or clearinghouse vendor(s) before the claim is adjudicated. These responses will specify if additional data elements are necessary. If you receive claim rejections, the affected claims must be corrected and resubmitted with the needed information as specified in the rejection message.

If you have questions regarding an electronic claim rejection message, contact your practice management/hospital information system software vendor, billing service or clearinghouse for assistance.

*These new validation edits do not apply to government programs (Medicare Advantage or Illinois Medicaid) electronic claim submissions.