![]() Code Section 140 are currently in process.įind more information at /hfs.The first few boxes are definitely self-explanatory. Tickets that are submitted in the new portal on or after will be processed under the new resolution process and applicable timeframes for submitting, monitoring, and resolving disputes between a provider and an MCO, as required by Public Act 101-0209 (SB1321). For existing open tickets, HFS will work to resolve them with the providers and MCOs expeditiously under the current process. Beginning , HFS will suspend/stop receiving complaints in the current portal. The link to the Resolution Portal is found on HFS’ Care Coordination Webpage, or may be accessed directly from the HFS Managed Care Provider Resolution Webpage. Effective, all providers will now submit unresolved issues with an MCO via the new secure web-based Provider Resolution portal. This notice is second in a series of notices regarding the implementation of the new provider MCO resolution portal. Second Notice: New HFS Provider Resolution Process and Portal Effective If you receive claim rejections, the affected claims must be corrected and resubmitted with the needed information as specified in the rejection message.įind more information on this and more at. These responses will specify if additional data elements are necessary. Providers submitting these claims electronically on or after April 1, 2020, may see new edit messages on the response files from their practice management system or clearinghouse vendor(s) before the claim is adjudicated. New Electronic Commercial Claim Validation Edits, Effective April 1, 2020Īs of April 1, 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement new electronic claim submission validation edits for commercial Professional and Institutional claims (837P and 837I transactions).* These claim edits will be applied to claims during the pre-adjudication process to help increase efficiencies and to comply with Medicare data reporting requirements. Revenue Codes Requiring Healthcare Coding System (HCPCS) Codes.On or after June 15, 2020, we will implement three new rules, as follows: We will soon update the ClaimsXten software database to better align coding with the reimbursement of claim submissions. ![]() ![]() Three New ClaimsXten™ Rules to be Implemented in June 2020 To help meet those needs, BCBSIL is accelerating the implementation of our Telehealth program.Įffective March 31, 2020, New Payment Policy for BCCHP and MMAI MembersĮffective with claims that have a processing date of March 31, 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) will not allow for reimbursement when mutually exclusive diagnosis codes are submitted for Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. We are helping employers.īlue Cross and Blue Shield of Illinois Expands Telehealth Program Effective March 10, 2020īlue Cross and Blue Shield of Illinois (BCBSIL) recognizes that BCBSIL members and providers may desire flexible options for access to care while our health care system is meeting the demands created by the coronavirus disease 2019 (COVID-19). Many of our members are covered under a health plan that is self-insured by their employer. ![]() Sometimes we can waive the timely filing requirement with a written request to appeal or reconsider.įind more information on this and more at .Įffective immediately, we won’t require prior authorization and won’t apply member co-pays or deductibles for testing to diagnose COVID-19 when medically necessary and consistent with Centers for Disease Control guidance. Sometimes you send in the claim but for some reason, we didn’t get it. Sometimes you get the wrong insurance information. Most providers have 120 days from the date of service to file a claim. In a perfect world, you should collect insurance information from members at the time of their visit and file the claim right away. Here’s how to request waivers of the timely filing policy ![]()
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