Search results with tag "Bcbsil"
ICD-10 Z Codes - BCBSIL
www.bcbsil.comthe utilization of ICD-10 Z code data, BCBSIL will be able to better understand the unique, social needs of BCBSIL members and help connect members with available resources. Blue Cross and Blue Shield of Illinois (BCBSIL) appreciates the care and attention you provide to our members.
Individual Plan Comparison Chart - BCBSIL
www.bcbsil.comIndividual Plan Comparison Chart Participating Provider Coverage Shown1 2022 All Blue Cross and Blue Shield of Illinois (BCBSIL) plans provide coverage for preventive services and maternity care. Please see your Summary of Benefits and Coverage or visit …
2022 - bcbsil.com
www.bcbsil.comIllinois since 1936. As a customer-owned health insurer, our focus is on our members, not shareholders. We work hard to make sure you have choices for your health care coverage. As health care in America changes, our dedication to our community will stay strong. BCBSIL will be here serving the people of Illinois, just as we have for 85 years.
1) Accessing Fee Schedules - BCBSIL
www.bcbsil.comThe AvailityFee Schedule tool allows professional providers participating with Blue Cross and Blue Shield of Illinois (BCBSIL) to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform.
Outpatient Facility and Hospital Claims: Revenue Codes ...
www.bcbsil.comCertificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents. BCBSIL may use reasonable discretion interpreting and applying this policy to services being delivered in a particular case. BCBSIL has full and final discretionary authority for their interpretation and application to the
The BlueCard Program Provider Manual - BCBSIL
www.bcbsil.comBlueCard Program Provider Manual – Reviewed 05/28/20 1 . The BlueCard® Program Provider Manual . May 2020. This manual is designed to offer you, as a Blue Cross and Blue Shield of Illinois (BCBSIL) independently
TABLE OF CONTENTS - BCBSIL
www.bcbsil.comBilling and Reimbursement BCBSIL Provider Manual — December 2020 4 8. Medically Necessary or Medical Necessity shall mean health care services that a Contracting Provider, exercising prudent clinical judgment, would provide to a …
Corrected Claim Submissions - BCBSIL
www.bcbsil.comBCBSIL may use reasonable discretion interpreting and applying this policy to services being delivered in a particular case. ... Plan Effective Date: May 1, 2020 Description A corrected claim is used to update a previously processed claim with new or additional information. A corrected
durable medical equipment - BCBSIL
www.bcbsil.comE1594: Cycler dialysis machine for peritoneal dialysis 19. K0738: ... BCBSIL Provider Manual—Rev 5/10 5 Group II criteria: an arterial PO2 of 56-59 MM Hg, or O2 saturation at or below 89 percent at rest ... Sleep Lab Study results must be available and provided upon request. Although all DME is billed and paid as a
Take Care of Your Heart — for Life
www.bcbsil.comBy making some good choices, you can boost your health and well-being. Get your copy of the BCBSIL wellness guidelines for adults and children on Blue Access for MembersSM at bcbsil.com or you can call the toll-free number on the back of your ID card.
Claim Review Form - BCBSIL
www.bcbsil.comClaim Review Form This form is only to be used for review of a previously adjudicated claim. Original Claims should not be attached to a review form. Do not use this form to submit a Corrected Claim or to respond to an Additional Information request from BCBSIL. Submit only one form per patient.
Multi-Tier Basic Drug List - BCBSIL
www.bcbsil.comDrug dispensing limits help encourage medication use as intended by the FDA. Dispensing limits are placed on medications in certain drug categories. For the medications listed in this document, if a dispensing limit applies, it will generally be noted next to the medication with a dot under the dispensing limits column.
5 Tier Basic Drug List - BCBSIL
www.bcbsil.comBlue Cross and Blue Shield January 2018 5 Tier Basic Drug List I Introduction Blue Cross and Blue Shield is pleased to present the 2018 Drug List. This is a list of preferred drugs which includes brand drugs and a partial listing of generic drugs. Members are encouraged to show this list to their physicians and pharmacists.
Availity Eligibility and Benefits User Guide - BCBSIL
www.bcbsil.comQuick Tip: →Only applicable benefits will be displayed. The below example does not show a maximum or limitation field; therefore, no maximum or limitations apply to this example. Below are examples of Benefit Descriptions that may return depending on the patient’s benefit contract. This information will be located under Coverage & Benefits ...
Authorizations User Guide - BCBSIL
www.bcbsil.comredirected to a third- party site. Page 5 of 12. Back to Home. Quick Tip: → Use . Select a Provider . to quickly populate required provider information. Administrators can refer to page 2 for Express Entry setup instructions. Authorizations User Guide . via Availity Essentials
2021-2022 Preventive Care Guidelines Table of ... - BCBSIL
www.bcbsil.comthe recommendations of other professional organizations that evaluate the value of clinical preventive services. The Guidelines represent a minimal set of recommended preventive health services. Additional interventions may be indicated, except where there is a
Provider Claims Inquiry or Dispute Request Form - BCBSIL
www.bcbsil.comc Claims Reversal Needed Reason: PLEASE NOTE: This form is for claim payment disputes related to reimbursement rate or processing. This form is NOT intended for requests related to clinical reviews for medical necessity determinations in the case of a denied authorization or retrospective review request.
Know Your Network Hospital(s) - BCBSIL
www.bcbsil.comBlue Cross and Blue Shield of IllinoisPPO, Blue Choice PPO SM and Blue Precision HMO Hospital Networks as of December 2014 Know Your Network. Your plan has its own provider network, a select group of doctors, clinics, hospitals and pharmacies that have agreed to provide a full range of covered health care services for your plan.
Social Security Number (SSN): Member ID: Sign Up for a ...
www.bcbsil.comN -APP-Off-E;-2022 1 32635.1021 Applicant Name: Social Security Number (SSN): Member ID: Internal Use Only Sign Up for a 2022 Health Plan for You and Your Family. You can visit bcbsil.com to sign up. If you are working with a Blue Cross and Blue Shield
2019 Formulary (List of Covered Drugs) - bcbsil.com
www.bcbsil.comii What is the Blue Cross Medicare Advantage Formulary? A formulary is a list of covered drugs selected by Blue Cross Medicare Advantage in consultation with a team of
2019 Formulary (List of Covered Drugs) - bcbsil.com
www.bcbsil.comiv What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact Customer Service and
Preventive Care Services: Contraception - BCBSIL
www.bcbsil.comPreventive Care Coverage at No Cost to You Effective Jan. 1, 2022 Your health plan may provide certain contraceptive coverage as a benefit of membership, at no cost to you when you use a pharmacy or doctor in your health plan's network. There is no copay, deductible or coinsurance, even if your deductible or out-of-pocket maximum has not been met.
Provider Refund Form - BCBSIL
www.bcbsil.comprovider cancelled charge for any reason; or claim incorrectly paid per contract. “Duplicate Payment” A duplicate payment has been received from BlueCross for one instance of service (e.g. same group and member number). “Not our Patient” …
Updated November 2021 - BCBSIL
www.bcbsil.com2021 Commercial Outpatient Medical Surgical Prior Authorization Code List PROCEDURES REQUIRING PRIOR AUTHORIZATION EXCEPT AS OTHERWISE NOTED IN THE UPDATES COLUMN, THESE PRIOR AUTHORIZATION REQUIREMENTS ARE EFFECTIVE ON JANUARY 1, 2021 PRESS "CTRL" AND "F" KEYS AT THE SAME TIME TO BRING UP THE SEARCH …
Blue Review December 2018 - bcbsil.com
www.bcbsil.comRead More Read More Read More Read More Read More HEDIS® Measures for Antidepressant Medication Management Major depression is one of the most common mental illnesses, affecting 6.7 percent (more than 16 million) American adults each year.
2021 Commercial Prior Authorization Requirements …
www.bcbsil.com2021 Commercial Prior Authorization Requirements Summary (Updated December 2020) This document provides an overview of services/care categories for which prior authorization may be required for some commercial, non-HMO Blue Cross and Blue Shield of Illinois (BCBSIL) members. Always check eligibility and benefits first via the Availity® Provider
Medicaid Prior Authorization Request Form - BCBSIL
www.bcbsil.comMedicaid Prior Authorization Request Form Please fax completed form to 312-233-4060 This information applies to Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. 242129.0121 FOR INTERNAL US ONLY UMC (WORK ITEM TYPE) URGENT (If checked, please provide anticipated date of …
Blue Cross and Blue Shield of Illinois Provider Manual ...
www.bcbsil.com• The right to health care when medically necessary as determined by your doctor and BCBSIL, 24 hours per day, 7 days per week for urgent or emergency care services and for other health care services as defined in the member handbook. • Choose a Primary Care Provider (PCP) or provider from the BCCHP network and be able to
Navigating Provider Finder - BCBSIL
www.bcbsil.comresults so you and our members can easily find in-network physicians, specialists and other health care providers. It’s important for you to review your information for accuracy. Below is a step-by-step guide to help you navigate Provider Finder. A B C. Complete at Least One of the Following
Individual Plan Comparison Chart - BCBSIL
www.bcbsil.com300 E. Randolph St. TTY/TDD: 855-661-6965 35th Floor Fax: 855-661-6960 Chicago, Illinois 60601 Email: CivilRightsCoordinator@hcsc.net You may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at: U.S. Dept. of Health & Human Services Phone: 800-368-1019
Dental Claim Form - BCBSIL
www.bcbsil.comA dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.) licensed by the state to practice dentistry, and practicing within the scope of that license. 122300000X General Practice 1223G0001X Dental Specialty (see following list) Various Dental Public Health 1223D0001X Endodontics 1223E0200X
The list below is for Provider contracting only ... - BCBSIL
www.bcbsil.com732 Advocate Condell Physician Partners Mt Prospect IL 60056 (847)298-6000 733 Advocate Dreyer Medical Clinic Aurora ; IL . 60506 (847)298-6000. 741 Amita Clinically Integrated Network Chicago IL 60625-3532 (630)312-7994 742 Advocate Sherman Physician Partners Mt. Prospect IL 60056 (847)298-6000
EFT and ERA Enrollment User Guide - BCBSIL
www.bcbsil.com4 6) Select Health Plan (Payer) Enter or select BCBS Illinois from the Health Plan (Payer) drop-down listing Choose the Provider Type (professional, institutional or both) Select Continue BCBS Illinois 7) Select Transaction Select Transaction (Electronic Remittance Advice, Electronic Payment Summary, and/or Electronic Funds Transfer) To receive ERA files when claims are …
Professional Provider Services - BCBSIL
www.bcbsil.comReimbursement Information: ... radiology reports. ... Split or shared visits is an E/M visit in the facility setting where services are performed in part by both a physician and a NPP who are in the same group, per applicable law and state/federal regulations, when the service could ...
2021 List of Covered Drugs (FORMULARY) - BCBSIL
www.bcbsil.comList of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter drugs and items are covered by Blue Cross Community MMAI. The Drug List also tells you if there are any special rules or restrictions on any drugs covered by Blue Cross Community MMAI. Key
Your guide to health, wellness and fitness
www.bcbsil.com• easyread.drugabuse.gov • samhsa.gov/families • connect.bcbsil.com (from the main page, choose Health and Wellness, then Healthy Mind or search by topic in the top search bar) Source: internal To find hours of operation, classes offered, virtual
2021 Holiday Schedule Reminders - BCBSIL
www.bcbsil.comThe reminders below are intended to assist providers in planning ahead for scheduling variances that may affect electronic claims (837) and/or claims payment and remittance (835) transactions in 202 1. Electronic Claim Reminders
Outpatient Preauthorization Caller Guide - BCBSIL
www.bcbsil.comOutpatient Request Preauthorization IVR Caller Guide 2 of 7 Interruption Permitted Preauthorization is required for certain services. A preauthorization determines medical necessity and the appropriateness of treatment. A predetermination may be used to obtain a benefit assessment but is not required. Predeterminations must be submitted in writing.
Take Advantage of Preventive Services - BCBSIL
www.bcbsil.comPreventive services are provided for women, men and children of all ages. For more details on what preventive services are covered at no cost to you, refer to the back of this flier for a listing of services, or see your benefits materials. Learn more on immunization recommendations and schedules by visiting the Centers for Disease Control and
Blue Cross and Blue Shield of Illinois Provider ... - BCBSIL
www.bcbsil.compredetermination is recommended when the service could be considered experimental, investigational or cosmetic. Predetermination approvals and denials are based on provisions in our medical policies. Medical policies may also be used as a guideline to determine what documentation may be required with the request. The Medical
Preventive Services Policy - BCBSIL
www.bcbsil.comertain preventive care services may be considered eligible for coverage under the member [s benefit plan as required by PPACA and/or an applicable state mandate. In general, these services include, but are not limited to, screenings, immunizations, and other types of care as recommended by the United States Federal Government.
B BlueAdvantage HMO and HMO Illinois Hospitals ... - BCBSIL
www.bcbsil.comAdvocate Condell Medical Center 801 S Milwaukee Ave Libertyville, IL 60048 (847) 362-2900 Advocate Condell Phys Partners #464 Advocate Good Samaritan Hospital 3815 Highland Ave Downers Grove, IL 60515 (630) 275-5900 Advocate Good Samaritan Phys Partner #294 DuPage Medical Group-Mid America #355 Advocate Good Shepherd Hospital 450 W Il Route 22
October 2021 COMMONLY PRESCRIBED DRUGS - BCBSIL
www.bcbsil.comipratropium bromide inhal soln . ipratropium-albuterol nebu soln . levalbuterol hcl soln nebu conc . montelukast sodium . QVAR REDIHALER . SEREVENT DISKUS . SPIRIVA HANDIHALER . SPIRIVA RESPIMAT . STIOLTO RESPIMAT . STRIVERDI RESPIMAT . SYMBICORT . terbutaline sulfate tab . theophylline tab er 24hr . TRELEGY ELLIPTA . zafirlukast tab ...
Formulary (List of Drugs) - BCBSIL
www.bcbsil.comIL_BCCHP_RX_Formulary20 Approved 09292020 . Member Services: 1-877-860-2837 • TTY/TDD: 711 • 24/7 Nurseline: 1-888-343-2697 i . WHEN YOU NEED TO CONTACT MEMBER SERVICES . ... we can arrange for a translator to help you. Please call Member Services at …
Provider Manual Blue Cross Community MMAI (Medicare- …
www.bcbsil.comAbout the Provider Manual This Provider Manual is designed to provide information regarding MMAI operations and plan benefits. BCBSIL shall notify independently contracted providers of any changes to the Provider Manual. If you have any questions regarding the information outlined in this Provider Manual, please contact the Provider
BlueCross BlueShield of Illinois - BCBSIL
www.bcbsil.comtraining and education, pediatric vision care, dental accident care, family planning services, outpatient contraceptive services, bone mass measurement and osteoporosis, investigational cancer treatment, infertility treatment, pediatric dental services, mastectomy related services, maternity services, and urgent care.
Claims Inuiry - BCBSIL
www.bcbsil.comPhysicians Care Network, INC. Claims Inquiry; Client Services 630 E Jefferson St; Rockford IL; 61107 (815) 963-6699 (815) 963-6965 managedcaresupport@arcadia.io; 099 1184718355 099; 1184718355 Dreyer Medical Clinic Advocate; Claims Inquiry Customer Service; PO BOX 0546 Mt. Prospect; IL 60056 (847) 298-6000 (847) 298-5802; ahpo-resolutionctr@aah ...
Similar queries
ICD-10 Z Codes, BCBSIL, Resources, Plan Comparison Chart, Owned, Schedule, Professional, Services, Of Health Care, Interpreting, BlueCard Program Provider Manual, BlueCard® Program Provider Manual, Manual, Corrected Claim Submissions, Date, Machine, Boost, Claim Review Form, Form, Claim, Corrected Claim, Multi-Tier Basic Drug List, Drug dispensing, Dispensing, Drug, 5 Tier Basic Drug List, Drug List, List, Eligibility and Benefits, Third, Party, Information, Administrators, Preventive Care Guidelines, Provider Claims Inquiry or Dispute Request Form, Claims, Reimbursement, For medical, Blue, Blue Shield, Covered drugs, Preventive Care Services: Contraception, Preventive Care, Provider Refund Form, Provider, 2021, 2021 Commercial Outpatient Medical Surgical Prior Authorization, Prior Authorization, Mental, 2021 Commercial Prior Authorization Requirements, 2021 Commercial Prior Authorization Requirements Summary, Commercial, Health care, Care, Navigating Provider Finder, Provider Finder, Randolph, Dental Claim Form, Dental, Or dental medicine, Advocate Condell, Advocate, EFT and ERA Enrollment User Guide, Electronic, Reimbursement Information, Radiology, Setting, List of Covered Drugs FORMULARY, Drugs, Easyread, Reminders, Outpatient Preauthorization, Outpatient, Preauthorization, Take Advantage of Preventive Services, Preventive, Control, Blue Shield of Illinois Provider, Experimental, Investigational, Medical, Preventive Services Policy, Under, States, Advocate Condell Medical Center, Ipratropium, Approved, Translator, Provider Manual Blue Cross Community MMAI Medicare, Provider Manual, Osteoporosis, Arcadia