This section provides a quick introduction to filing claims with BCBSIL. For additional information, including Timely Filing Requirements, Coordination of Benefits (COB), Medicare Crossover process and more, please refer to the BCBSIL Provider Manual.
Electronic Claims
You or your billing agent will need to utilize a third-party claims clearinghouse vendor such as Availity®to submit electronic Professional and Institutional claims (ANSI 837P and 837I transactions) to BCBSIL. For vendor options and information, referto theElectronic Commerce page.
- Advantages include greater security and accuracy of data, along with faster processing and payment.
- Claims may be submitted one-at-a-time by entering information directly into an online claim form on the vendor portal; or batch claims may be submitted via your Practice Management System (check with your software vendor to ensure compatibility).
- Electronic reports are generated and sent automatically to confirm receipt and identify any errors that need to be rectified prior to adjudication and payment.
Paper Claims
Please refer to the following websites for assistance withproper completion of paper claim forms:
- For CMS-1500 (Professional) claims, visit National Uniform Claim Committee (NUCC)
- For UB-04 (Institutional) claims, visit National Uniform Billing Committee (NUBC)
Commercial Claims
- Mail original claims to BCBSIL, P.O. Box 805107, Chicago, IL 60680-4112.
Government Programs Claims
There are different addresses for Blue Cross Community Health PlansSM,Blue Cross Community MMAI(Medicare-Medicaid Plan)SM and Blue Cross Medicare AdvantageSM claims. Mail original claims to the appropriate address as noted below.
- Blue Cross Community Health Plans, c/o Provider Services, P.O. Box 3418, Scranton, PA 18505
- Blue Cross Community MMAI(Medicare-Medicaid Plan), c/o Provider Services, P.O. Box 4168, Scranton, PA 18505
- Blue Cross Medicare Advantage, c/o Provider Services, P.O. Box 3686,Scranton, PA 18505
Additional Reminders
- Do NOT submit duplicate claims.
- To confirm receipt and adjudication progress,check claim status.
Out-of-area (BlueCard®) Claim Process
BlueCard is a national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to obtain health care services while traveling or living in another BCBS Plan’s service area.
- The program allows you to submit claims for members from other BCBS Plans to the Illinois Plan.
- The three-characterprefix preceding the member’s ID number is critical for proper routing of BlueCard claims.
- For complete details, refer to the BlueCard Program Manual.
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. BCBSIL makes no endorsem*nt, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
