Spring Updates from Blue Cross Blue Shield of Illinois

BCBS IL released several updates in their latest Blue Review affecting claims with multiple procedures, as well as DME benefit verification for select plans.

Regarding multiple procedures, BCBS IL announced that starting June 1, 2021 it will perform “additional reviews of claims” in order to identify possible overpayments. The review does not affect secondary, Medicare supplemental, or Medicaid replacement policies.

Per BCBS guidelines, claims with multiple procedures should see the most expensive procedure paid at 100% of the fee schedule, with all additional procedures paid at 50%. BCBS will perform recoupments on any claims they identify that they paid incorrectly. The most common error consists of paying two procedures both at 100%. 

In another spring update, BCBS IL released a new verification form to help streamline DME benefit checks for BCBS Medicare and Medicaid government plans (MMAI, BCCHP). See the link below to download the form. For relevant inquiries, complete section 1 of the form and email to the address listed in the instructions. BCBS IL states they will respond within two business days. Please note that this form does not apply to BCBS commercial plans.