![]() ![]() Meritain Health’s claim appeal procedure consists of three levels: Please forward this completed form to the privacy officer of the employer or to: The member whose information is to be released is required to sign the authorization form.Īll sections of the form must be complete for the form to be considered. Your signature and your understanding of what it means Purpose: why do you want the information released? Who you authorize to receive your PHI information for example, spouse, child or friend Employee information: if you are NOT the employee of the plan The following is a description of how to complete the form. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.The Authorization for Release of Information form is required according to the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA), specifically 45 CFR § 164.508 of the HIPAA Regulations. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. Availity provides administrative services to BCBSIL. Mental, Behavioral and Neurodevelopmental DisordersĪvaility is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. ![]() Asthma and Asthma-Associated Conditions.We’ve put together some documentation and coding tip sheets for the following conditions: High quality documentation and complete, accurate coding can help capture our members’ health status and promote continuity of care. For complete details, refer to the BlueCard Program Manual.The three-character prefix preceding the member’s ID number is critical for proper routing of BlueCard claims.The program allows you to submit claims for members from other BCBS Plans to the Illinois Plan.To confirm receipt and adjudication progress, check claim status.īlueCard is a national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to obtain health care services while traveling or living in another BCBS Plan’s service area.Blue Cross Medicare Advantage, c/o Provider Services, P.O.Blue Cross Community MMAI (Medicare-Medicaid Plan), c/o Provider Services, P.O.Blue Cross Community Health Plans, c/o Provider Services, P.O.Mail original claims to the appropriate address as noted below. There are different addresses for Blue Cross Community Health Plans SM, Blue Cross Community MMAI (Medicare-Medicaid Plan) SM and Blue Cross Medicare Advantage SM claims. If necessary, government programs paper claims may be submitted. Box 805107, Chicago, IL 60680-4112.Įlectronic claim submission is preferred, as noted above. If necessary, commercial paper claims may be submitted as follows: For UB-04 (Institutional) claims, visit National Uniform Billing Committee (NUBC)Įlectronic claim submission is preferred, as noted above.For CMS-1500 (Professional) claims, visit National Uniform Claim Committee (NUCC).Please refer to the following websites for assistance with proper completion of paper claim forms: ![]()
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