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Important Dates and Reminders

Check here each month for a quick snapshot of recent implementations, upcoming changes, special events, important deadlines and other reminders from
Blue Cross and Blue Shield of Illinois (BCBSIL). We know you're busy. While this list isn't all-inclusive, we hope this summary is useful.


Confirmation of Recent Implementations

Topic

Brief Description

Date Implemented:

For More Information

BCBSIL is participating in a Blue Cross and Blue Shield Association program for Group Medicare Advantage (PPO) members

BCBSIL will collaborate with you to identify gaps in care and retrieve medical records for claims you submit to BCBSIL for Blue Cross Group Medicare Advantage (PPO)SM members living in Illinois.

Jan. 1, 2020

National Coordination of CareSM Program to Serve Group Medicare Advantage PPO Members
(February 2020, Blue Review)

 

Upcoming Changes to Watch For

Topic

Brief Description

Target Implementation Date:

For More Information

New Benefit Preauthorization Submission Tool via Availity® Provider Portal

This new tool offers more convenient functionality, making it faster and easier for you to submit and receive confirmation of online requests.

Coming Soon (Previously Jan. 30, 2020)

Implementation Delay: Authorizations via Availity® Provider Portal
(January 2020, News and Updates)

Government Programs: Change to Hospital Readmission Payments

Consistent with the Centers for Medicare & Medicaid Services (CMS), BCBSIL will review acute hospital claims to determine if such readmissions to the same facility within 30 days of discharge are related and may deny payment to the hospital for related admissions.

March 1, 2020

Change to Medicare Severity Diagnosis Related Group Payment Methodology
(November 2019, News and Updates)

iExchange® Deactivation

BCBSIL’s electronic benefit preauthorization tool, iExchange, has been scheduled for deactivation. Start making the transition now so you’re ready to use the Availity Authorizations tool for requests for benefit preauthorization to be handled by BCBSIL.

April 15, 2020

Coming Soon: New Benefit Preauthorization Submission Tool via Availity Provider Portal
(February 2020, Blue Review)

Updates to ClaimsXtenTM Code-auditing Software

We will soon be implementing these ClaimsXten rules: Bilateral Services for Professional Claims; and Modifier to Procedure Validation Filter – Non-Payment Modifiers.

April 20, 2020

Two New ClaimsXten Rules to be Implemented in April 2020
(January 2020, News and Updates)

 

Special Events and Activities

Topic

Brief Description

Important Date(s)

For More Information

Monthly Hot Topics Webinar for Providers

Each month, our Provider Network Consultants (PNCs) will be hosting a Hot Topics webinar to help keep you up-to-date on important information you need to know to do business with us. You'll also get a chance to ask the PNCs questions.

This month's webinar will be on Feb. 12, 2020. Register today!

See the Webinars and Workshops page on our Provider website for upcoming dates, times and online registration.

 

Deadlines and Other Reminders

Topic

Brief Description

Important Dates

For More Information

Remind your patients that it’s not too late to get a flu shot.

Seasonal influenza activity in the U.S. is high. Typically, the peak of flu season occurs in February, but activity can last as late as May.

Through February 2020

Remind Your Patients: It’s Not Too Late for a Flu Shot
(February 2020, Blue Review)



Checking eligibility and benefits and/or obtaining preauthorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member's policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.


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. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. ClaimsXten is a trademark of Change Healthcare, an independent company providing coding software to BCBSIL. Change Healthcare is solely responsible for the software and all the contents. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, Medecision or Change Healthcare. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.