September 27, 2022
As an alternative to phone calls or faxing forms, you can use the Claim Inquiry Resolution (CIR) tool via Availity® Essentials to submit claim reconsideration requests online for certain commercial finalized claims. You’ll find the CIR tool in the Blue Cross and Blue Shield of Illinois (BCBSIL) branded Payer Spaces section on Availity.
Quick Tips for CIR Submissions
Here are some reminders to help you submit claim inquiries using the CIR tool:
- If your claim was processed within the last 18 months, select “Look Up Claim” on the inquiry screen to populate the Subscriber ID, Group Number, Patient Account, Patient Name and Date of Service on the next screen.
- If your claim processed prior to 18 months ago, select “Show More Fields” to manually enter this information on the next screen
- Only include medical records when they’re requested or required.
Required: Claim Number or Document Control Number
We’ll soon be rejecting inquiries that don’t include an appropriate claim number – also known as a document control number (DCN) – and we’ll ask for a correct claim number. To avoid a rejected inquiry, please ensure your request includes an appropriate claim number/DCN.
You can use the CIR tool for certain commercial finalized claims that require review relating to reasons outlined in the CIR user guide. The CIR tool cannot be used to:
- Obtain eligibility and benefits information
- Check claim status
- Submit formal claim appeals
- Submit predetermination requests
The CIR tool is not available for government programs (Medicare Advantage and/or Illinois Medicaid) claim inquiries.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors and the products and services they offer.