HFS IMPACT File Discrepancies Causing Claim Rejections for BCCHPSM
Posted October 8, 2020 (Updated October 23, 2020)
The Customer Service number has been corrected.
Providers rendering services to Blue Cross and Blue Shield of Illinois (BCBSIL) Blue Cross Community Health PlansSM (BCCHP) members are required to enroll and revalidate through the Illinois Department of Healthcare and Family Services (HFS) Illinois Medicaid Program Advanced Cloud Technology (IMPACT) portal. BCBSIL recently updated our systems to align with the HFS IMPACT file sent to MCOs weekly by HFS. As directed by HFS, our system will reject claims if a provider is listed as inactive for any reason on the HFS IMPACT file.
We recently became aware of some data discrepancy issues with the IMPACT file we receive from HFS. These issues may cause a provider to be depicted as inactive on the HFS IMPACT file in error. Consequently, this impacted our claim processing and claims were rejected in error.
We urge providers to validate and confirm the accuracy of their data on the HFS IMPACT portal, including effective dates and other data elements, prior to filing a claim. We are working closely with HFS in an effort to address the data discrepancies on the HFS IMPACT file.
To avoid disruption in our members’ care, our Pharmacy team has implemented an override process to ensure members receive medications while HFS reviews and resolves these issues. If the Pharmacy receives the following message, “Prescriber not enrolled in IMPACT,” and the provider is not active on the IMPACT file in error, the pharmacy may submit the claim with the override code 55555555555 at the point of sale, to receive claim reimbursement.
Feel free to contact our Customer Service at 877-860-2837 or your assigned Provider Network Consultant with any questions. We appreciate your patience as we continue to work through this process.