January 2022
Availity® Tools to Support Providers in 2022
In October 2021, we highlighted changes starting Jan. 1, 2022, related to the Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule. To further support you, the Availity Provider Portal helps providers and Blue Cross and Blue Shield of Illinois (BCBSIL) quickly and securely share information, including information defined by the CAA.
See below for a list of self-service tools you can access through the Availity portal. The list includes descriptions and links to related resources, such as instructional user guides and important tips.
Not yet registered with Availity? You can sign up now at no cost on Availity. For help registering, contact Availity Client Services at 800-282-4548. If you need customized training or help with these tools, contact our Provider Education Consultants.
Administrative Tools |
Descriptions |
More Resources |
| Provider Data Management (Professional providers only) |
Verify and update your provider directory information with BCBSIL every 90 days. |
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| Fee Schedule Listing (Professional providers only) |
Electronically request up to 20 procedure codes and immediately receive the contracted price allowance for services. | Fee Schedule User Guide |
Pre-Service Tools |
Descriptions |
More Resources |
| Eligibility and Benefits Inquiry | Check real-time patient eligibility, confirm coverage details, determine prior authorization requirements and view and/or print an image of the member’s ID card. | |
Availity Authorizations Tool |
Submit commercial, non-HMO prior authorization requests handled by BCBSIL |
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| Attachments: Predetermination Requests* | Submit predetermination of benefits requests handled by BCBSIL. | Predetermination of Benefits Requests User Guide |
| Research Procedure Code Edits (Clear Claim Connection™)* | Determine how coding combinations on a specific claim may be evaluated during the adjudication process. | Clear Claim Connection Instruction Guide |
| Patient ID Finder | Obtain the BCBSIL patient ID and group number. | Patient Care Summary User Guide |
| Patient Care Summary | Obtain a consolidated view of a patient’s health care history within the last 24 months. | Patient Care Summary User Guide |
| Patient Cost Estimator* | Estimate a patient’s potential out-of-pocket costs. | Note: This tool is currently unavailable for Federal Employee Programs® (FEP®) members. |
Post-Service Tools |
Descriptions |
More Resources |
| National Drug Code (NDC) Units Calculator | Convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units. | NDC Units Calculator Tool User Guide |
| Claim Status | Check enhanced, real-time claim status. | Claim Status User Guide |
| Remittance Viewer | View and reconcile claim data in the 835 Electronic Remittance Advice (ERA). | Remittance Viewer User Guide |
| Reporting On-Demand | View, download, save and/or print the Provider Claim Summary (PCS) for finalized claims. | Reporting On-Demand User Guide |
| Claim Inquiry Resolution (CIR)* | Submit claim reconsideration request for certain finalized claims. | CIR User Guide |
| Clinical Claim Appeal Requests** | Submit appeal requests for specific clinical claim denials using the Availity Claim Status tool, when applicable. | Electronic Clinical Claim Appeal Requests User Guide |
| Independent Dispute Resolution (IDR) | Initiate a claim dispute for non-contracted providers. |
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| Electronic Refund Management (eRM)* | Reconcile claim overpayments and manage refund requests. | eRM User Guide |
*Unavailable for Medicare Advantage and Illinois Medicaid members.
**Clinical Claim Appeal Requests are currently unavailable for Medicare Advantage, Illinois Medicaid and BlueCard® (out-of-area) members.
Checking eligibility and/or benefit information and/or obtaining prior authorization or pre-notification 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
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.
ClaimsXten and Clear Claim Connection are trademarks of Change Healthcare, an independent company providing coding software to BCBSIL. Change Healthcare is solely responsible for the software and all the contents.
CPT copyright 2021 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.