Blue Cross Blue Shield of Illinois Provider Services
February 2021
Availity® Provider Portal: Multiple Tools, One Location
The Availity Portal helps providers and Blue Cross and Blue Shield of Illinois (BCBSIL) to securely share information easily and efficiently. As a registered Availity user, you may quickly check our members' eligibility and benefits, confirm prior authorization requirements, submit prior authorization requests, check claim status, obtain provider claim summaries and more online, without having to call BCBSIL.
Why use Availity?
Here are some of the advantages of using Availity:
- Accessible 24/7
- HIPAA-compliant
- Multi-payer solution
- Real-time search results
- No-cost transactions
- Printable results
- Online "Help" features
What electronic tools are available?
See below for examples of the growing list of free self-service tools that are accessible through Availity to help you accomplish multiple tasks and gain information when providing care and services to our members.
| Pre-service Tools | Description |
| Eligibility and Benefits Inquiry | Verify real-time patient activity, obtain an image of the BCBSIL member ID card, check coverage details and determine prior authorization requirements |
| Patient Care Summary | Consolidated view of a patient's health care history |
| Patient Cost Estimator* | View an estimate of a patient's potential out-of-pocket costs |
| Patient ID Finder | Obtain the BCBSIL patient ID and group number |
| Authorizations tool | Submit prior authorization requests handled by BCBSIL, if applicable (does not apply to HMO) |
| Attachments* tool | Submit voluntary predetermination requests handled by BCBSIL, if applicable (does not apply to HMO) |
| Post-service Tools | Description |
| Altruista Health's GuidingCareTM (single sign-on access) | Monitor rendered services, activities, quality measures and care plans for Illinois Medicaid members |
| Claim Status | Check detailed, real-time claim status |
| Research Procedure Code Edits (Clear Claim ConnectionTM)* | Determine how coding combinations on a specific claim may be evaluated during the adjudication process |
| Reporting On-Demand | View, download, save and/or print the Provider Claim Summary (PCS) for finalized claims |
| Remittance Viewer | Offers providers and billing services a convenient way to view and help reconcile claim data in the 835 Electronic Remittance Advice (ERA) |
| Electronic Refund Management (eRM)* | Reconcile claim overpayments and manage refund requests |
| Claim Inquiry Resolution (CIR)* | Submit a claim reconsideration request for certain finalized claims |
| Medical Attachment tool | Receive and electronically respond to medical record requests for quality and risk adjustment |
| Clinical Quality Validation (CQV) tool | Comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures by electronically documenting the patient's care and assessment |
*Not available for Illinois Medicaid or Medicare Advantage members.
Not registered with Availity?
There's no charge to register, and it's quick and easy to sign up online for Availity. For registration help, contact Availity Client Services at 800-282-4548.
For More Information
Refer to the Provider Tools section of our website for details, such as user guides for the Availity offerings listed above. Also visit our Webinars and Workshops page to register for upcoming online training sessions.
Questions? Need customized training?
Email our Provider Education Consultants for help.
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. GuidingCare is a trademark of Altruista Health, a separate company that offers collaborative health care management solutions for payers and providers. Clear Claim Connection is a trademark of Change Healthcare, an independent company providing coding software to BCBSIL. Change Healthcare is solely responsible for the software and all the contents. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, GuidingCare or Change Healthcare. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
Source: https://www.bcbsilcommunications.com/newsletters/br/2021/february/availity_provider.html
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