Reminder: New BCBSIL Electronic Commercial Claim Validation Edits, Effective April 1, 2020

Posted March 31, 2020

This is a follow-up to a previous article, published in our March 2020 Blue Review.

Starting April 1, 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) began implementing enhancements to our electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions).* These enhancements allow claim edits to be applied to claims during the pre-adjudication process, giving you the ability to identify errors earlier in the process and make necessary corrections more quickly.

Clarification and Summary of Changes

  • Prior to April 1, 2020, electronic claim submissions were accepted into the BCBSIL adjudication system for processing and then denied when needed data elements were not included.
  • For electronic claims submitted on or after April 1, 2020, you may see new edit messages on the response files from your practice management system or clearinghouse vendor(s) before the claim is adjudicated. These responses will specify if additional data elements are required.
  • 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 Medicare Advantage or Illinois Medicaid electronic claim submissions.