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Introducing Electronic Clinical Claim Appeal Requests via Availity® Provider Portal

Posted November 1, 2021

Blue Cross and Blue Shield of Illinois (BCBSIL) is excited to announce a new and convenient electronic capability to submit appeal requests for specific clinical claim denials through the Availity Portal. This electronic option allows you to submit the clinical appeal request, upload supporting documentation, and monitor its status.  

A clinical appeal is a request to change an adverse determination for care or services when a claim is denied based on lack of medical necessity, or when services are determined to be experimental, investigational or cosmetic.

This new online offering allows for:

  • Status management
  • Uploading clinical medical records with the appeal submission
  • Viewing and printing confirmation and decision letters 
  • Generating a Dashboard view of appeal-related activity

Steps to submit appeal requests for clinical claim denials online:

  1. Log in to Availity 
  2. Select Claims & Payments from the navigation menu, then choose Claim Status
  3. Search and locate the claim by using the Member ID or Claim Number
  4. On the Claim Status results page, select Dispute Claim (when applicable)
  5. Complete the Dispute Request Form
  6. Upload supporting documentation
  7. Review and submit your appeal request

For help with obtaining claim status online, please refer to the Claim Status Tool User Guide .

Training
BCBSIL is hosting complimentary webinars for providers to learn how to use this new electronic clinical claim appeal Dispute tool. To register for a training session, select your preferred date and time below.

Availity Administrators need to assign their users the Claim Status role in Availity to ensure users can access and submit electronic appeals online. If your provider organization is not yet registered with Availity, you can sign up today at Availity , at no charge. For registration help, contact Availity Client Services at 800-282-4548.

For More Information
A new Electronic Clinical Claim Appeal Request User Guide  is available in the Provider Tools section of our website. Visit the Webinars and Workshops page for more webinar sessions in December 2021. If you need further help, contact our Provider Education Consultant team.

Note: This information is not applicable to Medicare Advantage, Illinois Medicaid claims or BlueCard® (out-of-area) claims.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity.