BLUE REVIEW^SM

June 2024

Electronic Claim Reconsideration Requests and Tips for Correct Use of Claim Review Forms

Electronic claim reconsideration requests are available for review and/or reevaluation of situational finalized claim denials online (including BlueCard^® out-of-area claims). This method of inquiry submission is preferred over faxed/mailed claim disputes, as it allows you to upload supporting documentation and monitor the status via Availity^® Essentials.

If you’re unable to submit electronic transactions, you can submit paper claim review requests by using the appropriate form on our website. Blue Cross and Blue Shield of Illinois must have all requested information to complete a proper claim review. Effective Aug. 1, 2024, we’ll return any incomplete form without conducting the claim review.

Here are some helpful tips when submitting paper requests for commercial claim reviews:

• To request a review of a previously adjudicated claim, use our Claim Review Form.
• Reference the claim number in the appropriate field on the form. Don’t attach original claims to your form.
• If you submit a Claim Review Form as a request for a second review, you must provide information not previously submitted to be eligible for review.
• To submit a corrected claim, use our Corrected Claim Form.
• To respond to an additional information request, use the Additional Information Form.
• For more information, refer to our Claim Review and Appeal page.

Remember, electronic options are available via Availity Essentials for faster, easier, more efficient claim review requests. Be sure to provide all required information as we won’t review electronic inquiries received with incomplete information.

Submit a Claim Review Request Online, Fast
To submit an online claim review request via Availity Essentials:

• Perform a Claim Status search utilizing the Member or Claim tab.
• Use the Dispute Claim or Message This Payer option to request a claim review.*
• Complete all needed information.

*Message This Payer is applicable for certain claim processing scenarios. Message This Payer will not be present in the claim status response if Dispute Claim is available for the finalized claim.

For more information on these electronic options, refer to our Claim Reconsideration Requests and Message This Payer pages.