December 2020
Submit Commercial Claim Reviews Online via the Claim Inquiry Resolution (CIR) Tool
The Claim Inquiry Resolution (CIR) tool offers you an online method to request claim reviews for certain finalized claims.* This tool can be used as an alternative option to request claim adjustments over the phone or via the Blue Cross and Blue Shield of Illinois (BCBSIL) Claim Review Form. Using the CIR tool can help save your staff time by reducing the need for phone calls and written correspondences to BCBSIL.
BCBSIL accepts the following claim inquiry types for reconsideration through the CIR tool:
- Medicare/Other Insurance Explanation of Benefits (EOB)
- Duplicate Denial
- Additional Information
- Fee Schedule/Pricing Inquiry
- Eligibility
- Federal Employee Program® (FEP®)
- Prior Authorization Denial
- I-Bill (HOST) Prepay High Dollar Review
Tips for submitting CIR inquiries:
- Submit one inquiry for each claim number that you are requesting for review.
- Avoid duplicate submissions of previously submitted claim inquiries.
This tool is located in our BCBSIL-branded Payer Spaces within the Electronic Refund Management (eRM) tool via the Availity® Provider Portal. You must first complete the eRM onboarding form to gain access to the CIR tool.
Not yet registered for Availity? Sign up for free at Availity. If you need help with registration, call Availity Client Services at 800-282-4548.
For More Information
Refer to the instructional CIR tip sheet located in the Provider Tools section of our website. If you need further education and/or customized training, email our Provider Education Consultants.
*The CIR tool is currently unavailable for Medicare Advantage and Illinois Medicaid claim reviews.
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 endorsement, 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.