September 2020
Submit Predetermination of Benefits Requests via the Availity® Provider Portal
Blue Cross and Blue Shield of Illinois (BCBSIL) is pleased to introduce an electronic predetermination of benefits request process via the Availity Provider Portal using the new Attachments tool. This new process became available to providers as of July 30, 2020, making it faster and easier to submit a predetermination of benefits request to BCBSIL.
As a reminder, a predetermination of benefits is a voluntary request for written verification of benefits prior to rendering services. BCBSIL recommends submitting a predetermination of benefits request if the service may be considered experimental, investigational or unproven, as specified within the BCBSIL Medical Policy.
You must be registered with Availity to use the new Attachments tool. You can sign up today at Availity, at no charge. For registration assistance, call Availity Client Services at 800-282-4548.
If you don’t have online access, you may continue to fax and/or mail predetermination of benefits requests along with a completed Predetermination Request Form and supporting medical documentation. If faxing supporting medical documentation for a previously submitted request, please include the request number.
How does the new online process work?
Submitting online predetermination of benefits requests through the Availity Attachments application is simple and convenient:
- Log in to Availity
- Select Claims & Payments from the navigation menu
- Select Attachments – New
- Within the tool, select Send Attachment then Predetermination Attachment
- Download and complete the Predetermination Request Form
- Complete the required data elements
- Upload the completed form and attach supporting documentation
- Select Send Attachment(s)
For More Information
An Electronic Predetermination Request User Guide is available in the Provider Tools section of our website. If you need further help or customized training, contact our Provider Education Consultants.
The information in this notice does not apply to requests for HMO, Illinois Medicaid or Medicare Advantage members.
Please note that the fact that a guideline is available for any given treatment or that a service or treatment has been predetermined for benefits, is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date the service was rendered.
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.