May 1, 2025 [Updated May 22, 2025]
A new training page link has been added to this notice for ease of webinar registration.
We’re making changes affecting prior authorization requests for members with Blue Cross Community Health PlansSM.
What’s changing: Effective Aug. 1, 2025, Carelon Medical Benefits Management will replace eviCore for prior authorization requests. Some prior authorization requests previously reviewed by eviCore will now be reviewed by Carelon or Blue Cross and Blue Shield of Illinois. First-level appeal reviews will move from eviCore to BCBSIL. We encourage you to attend a webinar to learn more about Carelon – see below for the schedule and go to the training page to register.
These changes don’t apply to claims for Blue Cross Community MMAI (Medicare-Medicaid Plan)SM.
What will be new no sooner than July 1, 2025
- Use Payer ID 66012 when you submit an electronic claim.
- The mailing address for paper claims with attachments is changing. Mail claims with attachments and dates of service on or after July 1, 2025, to this new address:
Blue Cross and Blue Shield of Illinois
PO Box 650712
Dallas, TX 75265-0712 - You may see updated processing explanation codes on your payment remittance, based on new system configuration.
Billing reminders
- Submit claims with appropriate taxonomy and frequency codes, aligning with Illinois Medicaid billing requirements.
- Add-on services will be paid according to provider eligibility.
- Multiple laboratory panels billed on a single date of service will be reimbursed using the practitioner fee schedule, in conjunction with lab panel rates sheet, up to the maximum lab panel amount.
To submit electronically: Continue to submit claims that don’t require attachments for processing electronically. Use Availity® Essentials to submit electronic professional and institutional claims (ANSI 837P and 837I transactions) to us.
For vendor options and information, refer to electronic commerce information.
To submit claims inquiries, disputes and service authorization disputes for BCCHP: Call 877-860-2837 to submit a provider claim inquiry or dispute by phone. Updated inquiry or dispute forms will be available on our website.
Watch News and Updates for information on ongoing changes to our program for BCCHP. Contact our Provider Network team if you have questions or need assistance.
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BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.