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 (PNC) 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 Predetermination of Benefits Requests Online

Attachments is an online tool in the Availity Provider Portal that allows you to submit electronic predetermination of benefits requests handled by Blue Cross and Blue Shield of Illinois (BCBSIL). Learn more

Availity® Authorizations

Authorizations is an online tool in the Availity Provider Portal that allows you to submit benefit preauthorization requests handled by Blue Cross and Blue Shield of Illinois (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

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

Our Claim Inquiry Resolution (CIR) tool is available via a tab in our Electronic Refund Management (eRM) system. By providing a method for online assistance with specific inquiries on finalized claims, the CIR tool can help save your staff time by reducing the need for phone calls and written correspondence. Learn more

Claim Status Tool

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

Clear Claim Connection

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

Clinical Quality Validation (CQV) Application

Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Learn more

CoverMyMeds®

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 Request via Availity®

The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal. Learn more.

Electronic Quality and Risk Adjustment Medical Records Requests

The Availity® Medical Attachment tool allows providers to receive electronic quality and risk adjustment medical record requests from Blue Cross and Blue Shield of Illinois (BCBSIL). 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

Medical Record Status Viewer 

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

The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. This electronic health record can help you identify gaps in care, missed prescription refills and possible drug interactions, and other "clinical flags" and treatment opportunities. 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

Provider Data Management (PDM)

Provider Data Management (PDM) is an online tool in Availity® Essentials that allows professional 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

Reporting On-Demand

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