What's New |
Blue Review Readership Survey 2023: Your Voice Matters
As we move into the final months of 2023, it’s time to check in with our readers once again. Does the Blue Review provide content that’s timely, easy to navigate and relevant to the needs of your practice? |
|
Electronic Options |
BlueApprovRSM Now Accepts Recommended Clinical Review (Predetermination) Requests – Attend a Training
BCBSIL continues to streamline the pre-service review process to reduce your workload with BlueApprovR. This tool, accessible in Availity® Essentials, now processes optional recommended clinical review requests – formerly called predetermination requests – for some medical and surgical and specialty pharmacy drugs for many of our commercial, non-HMO members. |
|
Pharmacy Program |
Select Medication List To Be Discontinued
Effective Dec. 1, 2023, the Select Medication List will be removed from our Provider website. The Select Medication List included specific medications eligible for increased reimbursement over similar medications within the same drug class, when billed with the appropriate National Drug Code pricing information. This pricing differential will be discontinued on Dec. 1, 2023. Read more on News and Updates. |
|
Reminder Regarding Billing for Point-of-Use Convenience Kits
BCBSIL regularly reviews claims submitted by providers to help make sure benefits provided are for services included in our member’s benefit plan and meet our guidelines. |
|
|
Pharmacy Program Updates: Prior Authorization Changes Effective Nov. 1, 2023
The BCBSIL pharmacy PA program encourages safe, cost‑effective medication use by allowing coverage when certain conditions are met. A clinical team of physicians and pharmacists develops and approves the clinical programs and criteria for medications that are appropriate for PA by reviewing U.S. Food and Drug Administration approved labeling, scientific literature, and nationally recognized guidelines. Read more on News and Updates. |
Claims and Coding |
Itemized Bills Required for Some Facility Claims Over $100K
Beginning Jan. 1, 2024, BCBSIL will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. This applies to facility claims billed at $100,000 or more, or as required by the member’s benefit plan, submitted for some BCBSIL commercial members.* |
|
|
New Mailing Address for Paper Commercial Claims
We’re updating our P.O. Box for paper claims to help expedite claims processing. Remember, electronic claim submission is preferred. |
|
Clinical Updates, Reminders and Resources |
Has your information changed? Let us know!
When seeking health care services, our members often rely upon the information in our online Provider Finder®. Prospective patients can use this online tool to confirm if your practice is a contracted in-network provider for their health care benefit plan. Other providers may use the Provider Finder when referring their patients to your practice. |
|
|
Updates to Clinical Practice and Preventive Care Guidelines
We’ve updated our Clinical Practice Guidelines and Preventive Care Guidelines. The guidelines draw from evidence-based standards of care and nationally recognized medical authorities to help direct our quality and health management programs and help improve member care. They may help guide your decision-making as you care for our members. Read more on News and Updates.
|
|
Prior Authorization Requirement Changes for Some Government Programs Plans Effective Oct. 1, 2023
BCBSIL is changing prior authorization requirements for Blue Cross Medicare Advantage (PPO)SM, Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SMmembers. Read more on News and Updates. |
Quality Improvement and Reporting |
Survey Assesses Medicare Advantage Members’ Health Outcomes
The Centers for Medicare & Medicaid Services sends a Health Outcomes Survey (HOS) to a sample of our members from August through November. The survey asks members in Blue Cross Medicare AdvantageSM and prescription drug plans to rate their last six months of care. |
|
|
2023 Illinois Medicaid Quality Improvement Program Updates
Beginning with the 2023 Performance Year, changes will be made to the Medicaid Primary Care Quality Improvement Program for participating providers with 1,000 or more members. |
|
Notification and Disclosure |
ClaimsXten™ Quarterly Update Effective Dec. 4, 2023
BCBSIL will implement its fourth quarter code updates for the ClaimsXten auditing tool on or after Dec. 4, 2023. |
|
|
 |
Reminders
Stay informed!
Watch the News and Updates on our Provider website for important announcements.
Verify and Update Your Information
Verify your directory information every 90 days. Use the Availity Essentials Provider Data Management feature or our Demographic Change Form. Facilities may only use the Demographic Change Form.
Provider Training
For dates, times and online registration, visit the Webinars and Workshops page.
|
|