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Updated Process for Urine Drug Testing (UDT) Claims for Illinois Medicaid Members

Posted April 22, 2021

This notice applies only to providers who submit claims for services rendered to our Blue Cross Community Health PlansSM (BCCHPSM) and/or Blue Cross Community MMAI (Medicare-Medicaid Plan)SM  members.

Blue Cross and Blue Shield of Illinois (BCBSIL) will soon begin sending letters to providers who submit UDT claims for our BCCHP and MMAI members without providing the necessary supporting documentation. Documentation requirements for UDT claims are outlined in the following BCBSIL Medical Policy: MED207.154, Drug Testing in Pain Management and Substance Use Disorder Monitoring.

Process for Claims Resubmission
If you submit a UDT claim without adequate documentation, the claim will be denied and you’ll receive a letter from BCBSIL, as noted above. You must resubmit the denied claim as a corrected claim (electronic or paper) along with the patient’s medical records to determine benefits for UDT and complete claim processing.

Your letter from BCBSIL will include details (patient information, claim number, date of service) and instructions for resubmitting the corrected claim. Include this letter when faxing or mailing the supporting documentation for your corrected claim.

For more information on submitting Electronic Replacement/Corrected Claims, refer to the Related Resources on the Claim Submission page. If you have any questions, call 877-860-2837 for BCCHP members or 877-723-7702 for MMAI members; or email your Provider Network Consultant (PNC).