IL BCBS Predetermination Request Form 2019 free printable template

Instructions for Submitting REQUESTS FOR PREDETERMINATIONS typically are not required. A predetermination is a voluntary, written request by a provider to determine if a proposed treatment or service

How to fill out IL BCBS Predetermination Request Form

How to fill out IL BCBS Predetermination Request Form

1. Obtain the IL BCBS Predetermination Request Form from the official BCBS website or your healthcare provider.
2. Fill in your personal information, including your name, address, and member ID at the top of the form.
3. Provide the details of the healthcare service or procedure that requires predetermination, including the specific code if available.
4. Enter the name and contact information of the healthcare provider requesting the approval.
5. Clearly explain the medical necessity for the procedure or service in the designated section.
6. Attach any supporting documentation, such as medical records, diagnostic reports, or letters from your healthcare provider.
7. Review the completed form for accuracy and completeness before submission.
8. Submit the form through the preferred method indicated by BCBS (fax, mail, or online portal).

Who needs IL BCBS Predetermination Request Form?

1. Patients seeking coverage for medical procedures or services to determine if they are medically necessary before they receive treatment.
2. Healthcare providers who need to secure pre-approval from BCBS to ensure that the services will be covered under the patient’s insurance plan.

People Also Ask about

Is Blue Cross Blue Shield the same as Blue Cross Blue Shield of Illinois?

About Blue Cross and Blue Shield of Illinois BCBSIL is a division of Health Care Service Corporation, a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.

How long do you have to file an appeal with BCBS of Illinois?

You must file your appeal within 60 calendar days from the date on the Notice of Action letter.

How do I get explanation of benefits from BCBS Illinois?

You may view the Explanation of Benefits (EOB) by going to the Claims Center tab on Blue Access for Members (BAM). This will provide you with a complete list of your claims for the past 18 months. You will need to click on the claim number hyperlink in order to access the EOB.

How do I appeal a Blue Cross Blue Shield of Illinois?

There are two ways to file an appeal or grievance (complaint): Call Member Services at 1-877-860-2837. If you do not speak English, we can provide an interpreter at no cost to you. If you are hearing impaired, call the Illinois Relay at 711.

What is the timely filing limit for BCBS of Illinois?

Claims must be filed with BCBSIL on or before December 31 of the calendar year following the year in which the services were rendered. Services furnished in the last quarter of the year (October, November and December) are considered to be furnished in the following year.

How to submit a claim to insurance Blue Cross Blue Shield Illinois?

Claims may be submitted one-at-a-time by entering information directly into an online claim form on the vendor portal; or batch claims may be submitted via your Practice Management System (check with your software vendor to ensure compatibility).

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What is IL BCBS Predetermination Request Form?

The IL BCBS Predetermination Request Form is a document used by healthcare providers to request pre-authorization for specific medical services or procedures from Blue Cross Blue Shield of Illinois.

Who is required to file IL BCBS Predetermination Request Form?

Healthcare providers who wish to obtain pre-authorization for certain treatments or procedures performed on their patients are required to file the IL BCBS Predetermination Request Form.

How to fill out IL BCBS Predetermination Request Form?

To fill out the IL BCBS Predetermination Request Form, providers need to complete the form with accurate patient information, details of the requested procedure, the medical necessity for the procedure, and any supporting documentation that may be required.

What is the purpose of IL BCBS Predetermination Request Form?

The purpose of the IL BCBS Predetermination Request Form is to obtain prior approval from Blue Cross Blue Shield of Illinois for a medical service or procedure, ensuring that it is deemed medically necessary and covered under the patient's insurance plan.

What information must be reported on IL BCBS Predetermination Request Form?

The IL BCBS Predetermination Request Form must report the patient's personal information, insurance details, the specific medical procedure being requested, the reasons for medical necessity, and any relevant clinical information or supporting documentation.