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  • Blue Cross Blue Shield Of Illinois Standard Authorization Form

Get Blue Cross Blue Shield Of Illinois Standard Authorization Form

Ase of his or her protected health information (PHI) to a specific person or entity. Please follow the instructions below for completing the Blue Cross Blue Shield of Illinois (BCBSIL) Standard Authorization Form to Use or Disclose Protected Health Information (PHI). If you need assistance in completing the authorization form, please call the Customer Service number listed on the back of your BCBSIL Membership Identification card. Please remember: One authorization form can be used for a ran.

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Electronic claim submission is preferred, as noted above. If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. Box 805107, Chicago, IL 60680-4112.

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).

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

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.

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.

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.

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.

A toll-free number, 1-800-676-BLUE, for healthcare providers to verify Blue Cross Blue Shield membership and coverage information for patients.

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© Copyright 1997-2025
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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