Provider Tools

These complimentary online applications can be used to accomplish tasks and gain information. Please note: Some of the tools may require registration through a third party vendor portal; and some tools may not be available for government programs at this time. Contact your Provider Network Consultant if you have questions.

Altruista Health's GuidingCareTM

Altruista Health GuidingCare is a web-based care management tool for providers to monitor rendered services, activates, quality measures and care plans for Illinois Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. Learn more

Availity® Attachments: Submit Recommended Clinical Review Requests

Attachments is an online tool in Availity Essentials that allows you to submit electronic recommended clinical review (formerly predetermination of benefits) requests handled by Blue Cross and Blue Shield of Illinois. Learn more

Availity® Authorizations

Authorizations is an online tool in Availity Essentials that allows you to submit prior authorization requests handled by BCBSIL. Learn more

Availity Eligibility and Benefits

It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.

To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information. Learn more


BlueApprovR is an online tool accessible in Availity® Essentials that allows providers to submit inpatient and/or outpatient prior authorization requests and check status for medical/surgical, specialty pharmacy drugs, and behavioral health services for many BCBSIL commercial non-HMO members. Learn More

Blue Distinction Centers®

Find facilities recognized for expertise in bariatric surgery, cardiac care, cancer care, cellular immunotherapy, fertility care, knee and hip replacement, maternity, spine surgery, substance use treatment/recovery and transplants on the Blue Distinction website. Learn more

Claim Inquiry Resolution (CIR) Tool – High-Dollar, Pre-Pay Reviews

Claim Inquiry Resolution (CIR) is available via a tab in our Electronic Refund Management (eRM) system. The CIR function provides a method for inquiry submission related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) and IL Local claims (Medical Records and/or Itemized Bills) handled by BCBSIL. Learn more

Claim Reconsideration Requests

The Claim Reconsideration request option allows providers to electronically submit claim reconsiderations for situational finalized claim denials (including BlueCard® out-of-area claims), using Availity® Essentials Dispute Claim capability, which is anchored off the enhanced Claim Status tool. Learn more

Claim Status

The Availity® Essentials Claim Status tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSIL. Learn more

Clear Claim ConnectionTM

Clear Claim Connection (C3) is a free online reference tool that mirrors the logic behind BCBSIL's code-auditing software.* You can use C3 to help determine how coding combinations on a particular claim may be evaluated during the adjudication process. Learn more


CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of the pharmacy PA program. Learn more

Electronic Claim Submission via Availity® Essentials

Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to Blue Cross and Blue Shield of Illinois (BCBSIL), at no cost Learn more.

Electronic Clinical Claim Appeal Requests

Dispute Claim allows providers to electronically submit appeal requests for specific clinical claim denials through Availity® Essentials. Learn more.

Electronic Refund Management (eRM)

The Electronic Refund Management (eRM) tool is designed to help simplify overpayment reconciliation and related processes. Learn more

Fee Schedules via Availity® (Professional Providers)

The Availity® Fee Schedule viewer tool allows participating professional providers in our Preferred Provider Option (PPO) and Blue Choice PPOSM networks to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform. Learn more

Manage My Organization in Availity® Essentials 

Manage My Organization in Availity Essentials allows administrators and administrator assistants to add, edit, and/or delete provider(s) information within your organization(s) for easy data entry when submitting transactions via Availity handled by BCBSIL. Learn More

Medical Record Status Viewer 

The Medical Record Status Viewer is an online application that allows providers to confirm receipt (up to four) of the most recent medical records submitted by mail or fax to Blue Cross and Blue Shield of Illinois (BCBSIL) for claim processing and prior authorizations. Learn More

Message This Payer Application 

The Message This Payer application in Availity® Essentials allows providers to send secure messages to Blue Cross and Blue Shield of Illinois (BCBSIL) for claim management questions and follow along with the conversation history. Learn More

National Drug Code (NDC) Units Calculator Tool

Use the National Drug Code (NDC) Units Calculator Tool to easily convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units. Learn more

OptiNet® Assessment Tool

OptiNet is an online assessment tool developed by American Imaging Management® (AIM)®  to collect modality-specific data from imaging providers. This tool is an enhancement to our Radiology Quality Initiative (RQI) program, which AIM administers for BCBSIL. Learn more

Patient Care Summary

Patient Care Summary is accessible via Availity® Essentials and provides an electronic health record sourced from claim-based information collected by BCBSIL from physicians, pharmacies, labs and other health care providers based on the last 24 months of claims data. Learn more

Patient Cost Estimator

The Availity® Patient Cost Estimator (PCE) tool is an online member liability estimator that can help professional providers estimate a patient's potential out-of-pocket costs in real-time for office and outpatient services provided to BCBSIL members. Learn more

Patient ID Finder

The Availity® Patient ID Finder tool allows providers to obtain the BCBSIL patient ID number and group number by entering patient-specific date elements. Learn more

Physician Efficiency, Appropriateness, & QualitySM (PEAQSM) Program

Our PEAQ program evaluates physician performance in a transparent and multidimensional way. Its goal is to work with the physician community to maximize physician efficiency, appropriateness, and quality of care. Learn more

Plan Documents Viewer

The Plan Documents Viewer is an application in Availity® Essentials that allows providers contracted with BCBSIL to view, download and/or save National Drug Code (NDC) Fee Schedules. Learn more

Provider Correspondence Viewer

Provider Correspondence Viewer (PCV) is an online application accessible through Availity® Essentials that allows participating providers with Blue Cross and Blue Shield of Illinois (BCBSIL) to view, download and/or save specific documents related to the NPI and Tax ID associated with your Availity registration. Learn more

Provider Claim Summary 

The Availity® Provider Claim Summary application allows users to readily view, download, save and/or print Provider Claim Summary (PCS) reports online, at no additional cost. Learn more

Provider Data Management (PDM)

Provider Data Management (PDM) is an online tool in Availity® Essentials that allows professional, facility and ancillary providers to quickly update, validate and attest to the accuracy of their information on file with Blue Cross and Blue Shield of Illinois (BCBSIL). Learn more

Remittance Viewer

The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSIL in the 835 Electronic Remittance Advice (ERA). Learn more