BLUE REVIEW^SM

March 2024

Changes Coming to Claim Inquiry Resolution – Itemized Bill Review Only

The Claim Inquiry Resolution tool within the Electronic Refund Management portal only accepts inquiry submissions related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard^® out-of-area) and Blue Cross and Blue Shield of Illinois Local claims (Medical Records and/or Itemized Bills). The other inquiry options that were available via CIR have transitioned to the Dispute Claim or Message This Payer features.

As of Jan. 27, 2024, any request submitted through CIR that is not for review of an Itemized Bill high dollar pre-pay review will be rejected.

To prepare for this change, start using the Dispute Claim or Message this Payer options now. Both functions are available after performing an Availity^® Essentials Claim Status search by using the Member and/or Claim Number tabs. Using these options ensures that the claim inquiry is handled as priority over faxed or mailed receipts. 

The below information provides an overview of the Dispute Claim (Claim Reconsiderations) and Message This Payer options.

Dispute Claim – Claim Reconsiderations
A claim reconsideration is a request to review and/or reevaluate situational finalized claim denials online (including BlueCard out-of-area claims). This type of inquiry submission is the preferred method as it allows you to upload supporting documentation and monitor the status.

Use this online offering to:

• Manage status
• Upload supporting documentation with your submission
• View and print the confirmation and decision
• Generate a Dashboard view of claim reconsideration request activity
• View uploaded documents after attaching them to the request*

*Note: Uploaded attachments may take minutes to hours before they are viewable in the request.

For more details, refer to the Claim Reconsideration Requests page and instructional user guide on our website.

Claim Reconsiderations is not currently available for Illinois Medicaid or Medicare Advantage claims.

Message This Payer
The Message This Payer option allows you to send secure messages to BCBSIL for claim management questions and follow along with the conversation history. Once a message is submitted to BCBSIL, you will receive a response within two business days in the Messaging queue on the Availity Essentials homepage.

Use this online option to: 

• Initiate a message to BCBSIL from the Availity Claim Status tool
• Receive an online response from a BCBSIL associate
• Monitor message status via a dashboard view
• View and print conversations

For more details, refer to the Message This Payer page and instructional user guide on our website.

Message This Payer is not currently available for Illinois Medicaid, Medicare Advantage or BlueCard (out-of-area) claims.

Attend Instructor-Led Training Webinars
Visit our provider training page to register for upcoming training sessions to learn more about electronic tools available to help you streamline claim review processing.

You must be registered with Availity to gain access to Claim Reconsiderations via Dispute Claim or Message This Payer applications. Not an Availity Essentials registered user? Go to Availity and complete the online guided registration process, at no cost. If you need help with Availity registration, contact Availity Client Services at 800-282-4548.

For more information:

• Email our Provider Education Consultants if you have any questions on accessing these tools or need customized training.
• Continue to watch our Blue Review and News and Updates for future announcements, resources, and training opportunities.