Service Authorization Disputes – Service authorization disputes cover the following non-claims scenarios and should be filed by using the Provider Service Authorization Dispute Resolution Request form. Claims inquires do not result in a claim outcome review and are intended to address the following: Note: If the dispute is not resolved to your satisfaction, you may contact your Provider Network Consultant (PNC).Ĭlaims Inquiries – Claims inquiries can be submitted to BCBSIL Customer Service by phone (87), fax or mail using the same form as the claims dispute form found here. The letter will include the reference number, claim number, and describe whether the claim outcome was upheld or overturned along with a reason for this outcome. Upon completion of its review, BCBSIL will send a response letter to the submitter detailing the results of the review. Submission of any other ticket type to the HFS portal is not appropriate. The process described above must be followed for the issue to be accepted by HFS. The reference number described above must be used to submit any complaints regarding claims to the HFS portal. Note: More information on the use of the unique tracking ID in relation to the Healthcare and Family Services (HFS) Provider Complaint Portal can be found on the HFS website. The remaining digits uniquely identify the dispute in the BCBSIL system.Next 3 digits are the date or the calendar day BCBSIL received the dispute, for example, 345 represents December 11 (the 345 th day of the year).First two digits are the year BCBSIL received the dispute: 19.Unique Tracking ID Number/Reference NumberĪll BCBSIL claim disputes are associated with a 12-digit number, which will appear in the following format: 193450004656 For status updates, call Customer Service at 87 and ask for a reference number for your dispute.Fax or mail the form to the contact information on the form.Include all requested information on the form.Complete the Provider Claims Inquiry or Dispute Request Form.The Customer Service representative will provide you a reference number, which can be used to track the dispute.You must indicate that you want to file a claims dispute.File the dispute by calling Customer Service at 87.You may file a claims dispute by calling Customer Service or faxing/mailing a form. Note: If you believe a claim was processed incorrectly due to incomplete, incorrect or unclear information, you should submit a corrected/replacement claim through the claim submission process instead of a claims dispute. BCBSIL gives in-network and out-of-network providers at least sixty (60) days to dispute a claim after the Plan has partially paid or denied it. If you feel the claim was incorrectly paid or denied, you can file a claim dispute.

After processing, the claim will be paid, partially denied or denied. For your convenience, we’d like to provide a reminder overview here.Īs you know, when you bill for the services rendered, the claims are sent to the Blue Cross and Blue Shield of Illinois (BCBSIL) claims department for processing. If you are a provider who is contracted to provide care and services to our Blue Cross Community Health Plans SM (BCCHP SM) and/or Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members, you are likely familiar with our provider claims dispute process. Secondary claim timely filing begins at date of primary claim final adjudication.July 2020 Provider Claims Dispute Process Overview for Government Programs.Primary claim timely filing begins at date of services rendered.Note: The standard guideline for timely filing with Coordination of Benefits (COB) is as follows and will not be changing: This new process is for members with a BCBSIL health plan and another plan with BCBSIL or one of the other four Plans listed above. These changes will help decrease the time it takes to process and coordinate payment of these claims. Next, submit the secondary claim with the primary claim payment information under the secondary policy following the COB guidelines documented in the Provider Manual.You’ll receive the determination on the primary claim through your normal channels detailing the primary claim adjudication.First, you’ll submit just the primary claim.Blue Cross and Blue Shield of New Mexico.As of Dec 13, 2021, we’ll be making changes to increase efficiencies in coordinating claims for providers when a Blue Cross and Blue Shield of Illinois (BCBSIL) member has primary and secondary health insurance coverage from two BCBSIL health plans or BCBSIL and one of the following four Plans:

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