Itemized Bills Required for Some Facility Claims Over $100k

September 25, 2020

This notice has been updated to add a reference to BlueCard®.

Beginning Jan. 1, 2021, Blue Cross and Blue Shield of Illinois (BCBSIL) will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. This applies to all facility claims over $100,000 submitted for BlueCard out-of-area Blue Cross and Blue Shield members or as required by the member’s benefit plan. An itemized bill helps ensure an accurate claim payment and reduces the need to submit more information after a claim is paid.

What’s Changing
The claim amount requiring itemization will be lowered to $100,000 from the current $200,000 threshold.

How to Submit Itemized Bills
You may submit itemized bills electronically using our Claim Inquiry Resolution tool. Include the corresponding claim number for quicker review and turnaround time.

More Information
Refer to our Inpatient/Outpatient Unbundling Policy (Clinical Payment and Coding Policy 002) for more information. If you have any questions, please contact your BCBSIL Provider Network Consultant.