Blue Review
A newsletter for contracting institutional and professional providers

October 2019

Quick Tips and Reminders from Our Provider Network Consultants

Our Provider Network Consultants (PNCs) serve as the liaison between Blue Cross and Blue Shield of Illinois (BCBSIL) and our independently contracted provider community, developing and maintaining working relationships with providers. Based on feedback from providers, we would like to share some quick tips and reminders for you and your staff.

  • Remember to read our monthly newsletter, Blue Review, and check the News and Updates section on our website. We'd be happy to add your email address to our database for electronic communications, such as the Blue Review.
  • Call the Provider Hotline, Provider Telecommunication Center (PTC) at 800-972-8088 first before reaching out to your PNC. You may get your answer in minutes. Make sure you receive a reference number if you need further assistance.
  • 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. (Note: The CIR tool is not currently available for government programs claim inquiries.)
  • Our Provider Relations team provides free training opportunities for providers, billing services, clinical and administrative staff members who are new or already participating in the BCBSIL network. Check the  Webinars and Workshops page for current listings.
  • A Mass Review can be requested if you have 75 or more claims for multiple patients that need to be reviewed for the same reason due to a system discrepancy, Service Center processing error, or provider billing error such as incorrect NPI, incorrect performing provider, etc. To request a Mass Review, fax a cover letter and spreadsheet with the claim numbers, member’s group and subscriber ID, date of birth and date of service to 312-565-1559. A representative will be assigned to work directly with you and a confirmation email will be sent to verify receipt. (Note: A Mass Review request must be submitted via fax. We no longer accept mailed inquiries.) 
  • The Provider Tools page on our Provider website offers details on free online applications to help you accomplish tasks and gain information. Check out the tip sheets in this section for quick reference.
  • Fee Schedules are released three times a year – January 1, June 1 and October 1. To receive a copy of the fee schedule, use the Fee Schedule Request form found on the Forms page. 
  • Provider Manuals are comprehensive guides for government, PPO and HMO providers. These manuals set forth the detailed policies, procedures and requirements necessary for participation in the BCBSIL contracting provider networks and can be found in the password-protected section of our website. Follow the links on the Secure Content page if you need information to gain access.
  • 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. Find more information, including the BlueCard Program Provider Manual, on the BlueCard Program page.

This is just a brief listing of tips for quick reference purposes. As always, if you have questions or need additional information, you are welcome to contact your PNC for assistance. If you don’t know who your PNC is, refer to the Provider Network Consultant Assignments page on our Provider website.