Why BCBS Illinois Isn’t Paying You Back

It can be impossible to get a human on the phone at BCBS Illinois if enrollment issues are preventing claims from paying

Blue Cross Blue Shield of Illinois (BCBSIL) is one of the many insurance companies in the United States that requires out-of-network providers to complete paperwork before they will process out-of-network claims from your practice. If you don’t complete this step, your patients’ out-of-network claims will not be processed and they will never get their money back. At Better, we put together this guide to save you time.

How Better Can Help Providers

In addition to the step-by-step instructions below, our team at Better is happy to answer any questions and assist you through this process free of charge. Email us your questions at providers@getbetter.co – we’re here to help!

Why is Enrollment Necessary For Out-of-Network Providers?

In 2015, like many other Blue Cross Blue Shield insurance companies, Blue Cross Blue Shield of Illinois (BCBSIL) instituted a new policy requiring all healthcare providers — even those who take no insurance — to complete out-of-network enrollment paperwork. Completing this process adds you and/or your practice to their computer system. Without this, BCBSIL will not process out-of-network claims from your practice.

How the BCBSIL process works

In the case of BCBSIL, to apply as a non-participating provider, we recommend using their application form. You may be advised, either by checking the BCBSIL website or speaking to a Provider Services representative, to create a CAQH profile to make your practice information available for BCBSIL. However, BCBSIL will only access a CAQH profile when creating an in-network provider record. CAQH profiles are not used to create out-of-network provider records.

The Application Form

The BCBSIL application form is simple and easy to fill out:

Note: BCBSIL advises writing “Out-of-Network Provider” along the top of the form to avoid any processing errors with BCBSIL.

1) Tax and Billing Information

This is where you fill in your EIN or Social Security number.

2) NPI and Government Identification

If you are a group practice, add your Type 2 NPI number. Each individual provider in your practice will also need to fill in a copy of the section marked Part 4.
If you are an individual provider, you add your Type 1 NPI number. (If you need to obtain an NPI, here’s how.)

3) Practice Information

This is where you fill in the basic information about you and your practice, including information about your specialty, locations, hours, office staff, and licensure.
You can enter two locations on the form. Other locations must be listed on office letterhead and attached to the form.
If there is more than one site and more than one provider, indicate which location each provider will be practicing.

4) Required for each provider (For Group Practices)

If you are a group practice, each individual provider must fill in copy of this section. There is no need to fill in the line marked CAQH# — this field is for providers who want to join the BCBSIL network.

5) Attestation

This section verifies that the information you are providing is correct and accurate and that your medical practice is compliant with applicable laws.

6) Review and submit your application

Once your application is complete you can submit it to BCBSIL by fax or mail:

Via Fax

312–540–8609

Via Mail

BlueCross BlueShield of Illinois
300 E Randolph
Chicago, IL 60601

How to Get Help

If you would like to reach out to BCBSIL directly with questions, you can send an email or leave a voicemail for the Provider Operations department:

Via Email

netops_provider_update@bcbsil.com

Via Phone

312–653–6555

Request brochures to share Better with your patients. The Better team is here as a free resource for providers to answer any questions you have about insurance, billing, or coding — email us at providers@getbetter.co!