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® 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


Behavioral Health Eligibility and Benefits

Behavioral health professionals and physicians may obtain benefits information for Blue Cross and Blue Shield members using the Availity® Eligibility and Benefits (E&B) tool. This free online tool can provide you with copayment, coinsurance, deductible, and other important information. Learn more


Blue Distinction Centers®

Find facilities recognized for expertise in bariatric surgery, cardiac care, cancer care, knee and hip replacement, maternity, spine surgery, and transplants on the Blue Distinction  website. Learn more


CareCost EstimatorSM

The Availity® CareCost Estimator (CCE) 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


Claim Encounter Reconciliation Application (CERA)

The Availity® Claims Encounter Reconciliation Application (CERA) helps providers manage and respond to BCBSIL if potential coding opportunities are identified – based on claims data – for members with on and off-exchange health plans. 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 Research Tool

The Claim Research Tool (CRT) offers enhanced, real-time claim status functionality to help you manage and resolve your BCBSIL claims. To gain access to the CRT, you must be registered with Availity® . 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 Refund Management (eRM)

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


iExchange®

Our automated preauthorization tool  iExchange supports direct submission and provides online approval of benefits for inpatient admissions, as well as select outpatient and pharmacy services 24 hours a day, seven days a week with the exception of every third Sunday of the month when the system will be unavailable from 11 a.m. to 3 p.m. (CT). iExchange is accessible to physicians, professional providers and facilities contracted with BCBSIL. 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

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 opportunitiesLearn 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