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  • Clinical Update Form - Blue Cross Blue Shield Of Illinois

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FOCUSED OUTPATIENT MANAGEMENT PROGRAM BlueCross BlueShield of Illinois Clinical Update Request Instructions: Please fill out and print, or print form and fill out legibly in black ink. Fax to BCBSIL.

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Contact Us Contact Name/DescriptionURL/Email/Phone/FaxBehavioral Health Unit1-800-851-7498 FEP: 1-800-779-4602 Fax: 877-361-7656 BCBSIL BH Unit PO Box 660240 Dallas, TX 75266-0240BlueCard® Hotline Call for out-of-state member eligibility and benefits1-800-676-BLUE (2583)11 more rows

If you want to know more about this process or how decisions are made about your care, contact Member Services at 1-877-860-2837 (TTY/TDD: 711).

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).

Including home health care services, durable medical equipment, behavioral health (mental health/substance use disorder) and the Prior Review List. The Avalon portal will not be available until 4/23. Please fax the completed form to Avalon's Medical Management Department at 813-751-3760.

BCBSIL only accepts medical records through the Availity Portal in response to requests for additional medical record documentation used for quality and risk adjustment purposes. Administrator Instructions: Select Availity Enrollment Center > Medical Attachments Setup, then enter required data.

Prior authorization is required for some members/services/drugs before services are rendered to confirm medical necessity as defined by the member's health benefit plan. A prior authorization is not a guarantee of benefits or payment.

Plan from seeking additional information or documents from Provider in relation to its review of other requests or matters. 10. Fax each completed Predetermination Request Form to 800-852-1360. If unable to fax, you may mail your request to BCBSIL, PO BOX 805107, Chicago, IL, 60680-3625.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232