eviCore healthcare (eviCore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. Medicaid Prior Authorization Request Form, Provider Service Authorization Dispute Resolution Request Form. R{O *L%U}r?:B22Rj=]p ($c j `-g [W}]blE&rT}TmPi]`8*I/,%,((56eA lLlkFy_&df4]`)`m9lrSQHp*:Y0T"NEAu:",@vR8za7nn7I,Iz-rSroq@T#}MW *7I :=C;hEQQq_1d"A B M$ }u$z GDChv0O{Q~ $W0!&~(c~;=1^!GD=q2z5OR%AG.)H&lz'9|^f!(@.ib PDF Medicaid Prior Authorization Requirements Summary, Effective Jan. 1 Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL The Customer Service representative will provide you a reference number, which can be used to track the dispute. R'sYI D@ zmG@5msm!T%FN3_z. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. In addition, some sites may require you to agree to their terms of use and privacy policy. You are leaving this website/app ("site"). Prior Authorization Support Materials (Government Programs) - BCBSIL Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. <>/Metadata 528 0 R/ViewerPreferences 529 0 R>> Our doctors and staff make decisions about your care based on need and benefits. Clear and timely submission of prior authorization requests and clinical documentation is very important to process requests within the required timeframes. Subscribe now to receive the monthly Blue Review via email. 6C("=L,`YF'0 d Refer to important information for our linking policy. Request a new replacement member ID card, or download a temporary copy. Personal health-related items (such as a toothbrush and toothpaste) are not included on this list. For some services/members, prior authorization may be required through BCBSIL. Your doctor will need to request approval before these drugs can be prescribed. All Rights Reserved. Our doctors and staff make decisions about your care based only on need and benefits. 12 0 obj <> endobj 64 0 obj <>/Filter/FlateDecode/ID[<377B542E37144E99AA8D3C27588EFAA9><9D42E3C64D6B4195AB6A428BC62E2046>]/Index[12 96]/Info 11 0 R/Length 151/Prev 468246/Root 13 0 R/Size 108/Type/XRef/W[1 3 1]>>stream Create an account. related information. From Essen-Kupferdreh back with the S-Bahn to the main station and from there without changing with the RE 16 back to Siegerland. endobj Customer Service: File the dispute by calling Customer Service at 1-877-860-2837. For more than 85 years, weve provided our members with comprehensive, affordable health plans, making Illinois a healthier place to live, work and play. File is in portable document format (PDF). BCBSIL Provider Manual | Blue Cross and Blue Shield of Illinois Home Doctors are not paid to deny care. Medicaid | Blue Cross and Blue Shield of Illinois - BCBSIL The site may also contain non-Medicare related information. hb``0b`0 36 fah@t#(f`XU1U B)xPB2@+4s\ X:EolHd]1ofxF/120i7@ZN 4`SBa@3P]8D5/@ F& endstream endobj 13 0 obj <>]/Pages 10 0 R/Perms/Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/Type/Catalog/ViewerPreferences<>>> endobj 14 0 obj <. PDF Post-Acute Care Utilization Management Program for Blue Cross and Blue Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com This new site may be offered by a vendor or an independent third party. If an appeal has been filed, the peer-to-peer discussion is no longer available. Your plan does not encourage doctors to give less care than you need. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. The next highest ascent for historic site trails is Von Wetter zum Nacken with 664 m of elevation gain. Blue Cross and Blue Shield of Illinois (BCBSIL) would like to outline some important updates, tips and reminders on prior authorization processes for independently contracted providers treating our Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. This step will help you confirm prior authorization requirements and utilization management vendor information, if applicable. Copyright 2021 Health Care Service Corporation. Talk with your doctor about your medication. Wetter - Kupferdreh Ruhrradweg | Map, Guide - North Rhine-Westphalia One option is Adobe Reader which has a built-in screen reader. Qf#yQ>u(KpRE{UIQp[)5T:p:jBFp*WWhwIA36YwNG)!G/!Yr6v7e|12 rUp3?R1H-6Kre vh) yj?O&y]\x,$aU7Mm'a 5a1owahiT@IC+ Choose the best payment option for your Blue Cross and Blue Shield of Illinois (BCBSIL) monthly bill. DentaQuest is an independent company that provides dental benefits for BCBSILs Medicaid plans. To view this file, you may need to install a PDF reader program. New to Blue Access for Members? Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Want to be part of our amazing team? Were hosting quarterly Community Stakeholder Committee meetings to find ways to better serve our Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Community Health PlansSM(BCCHP) members. External link You are leaving this website/app (site). All Rights Reserved. Get the most from your BCBSIL pharmacy benefits. Medical Policies are based on scientific and medical research. {0c8Lp~#g.wS,#.z (c PT+ ~"%V3xCh`q'cgI$i%0!J"Cd"$| wFx&U K>txE |3Z$IJri]d(I,14)ze49E]'o|E1F |o%BIwF=";v=sN&./"G0'89)JuJ.v@FiS_$.xpP*GMG"g'K;KmVGA?7nW/pJ'3P.u'7y*6#E!LbC?hhCp6 4y%CS"R;%j)`y31pc`{%w)/*5hKE7:KRnQ&C+grc-pG`3P8+C~J7X 3o'YBa@sOz0zRlA_>]B]]#@W)o)|CNogbC;, jXw8w;![@0\bBJh1e8M'Z9owf;CYP[Hk`|8 (d/v_59=_O~o=pn[3f5+@tn0M|!ev"]"A!^A cc=zZf` sDH- rst !-`*M68G#gYmw/|O|)- These include prior authorization code lists with effective dates and related information for Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. Please note that, effective May 1, 2021, there will be a change to the BCCHP peer-to-peer discussion process, as specified below. These requests must be decided within 48 hours for BCCHP members, and 72 hours for MMAI members. Lunch will be provided. All Rights Reserved. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. <> Stay informed about BCBSIL programs, products, initiatives, and more. 0 These tools used by PCPs (or specialists) include medical codes. To view this file, you may need to install a PDF reader program. Join us as we build the next generation of health insurance. Frequently asked questions about historic site trails in Wetter. eviCore healthcare (eviCore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. Government Programs Prior Authorization Summary and Code ListsRefer to the Summary documents below for an overview of prior authorization requirements, reminders and helpful links. For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. Life changes happen at any time. A provider may initiate a peer-to-peer discussion by calling 800-981-2795. 3oDiCBG\{?xyH BCBSIL adheres to the standards for addressing all urgent concurrent requests, meeting or exceeding National Committee for Quality Assurance (NCQA) standards. 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. Getting Care Through MMAI | Blue Cross and Blue Shield of Illinois - BCBSIL The peer-to-peer discussion is not required, nor does it affect the providers right to an appeal on behalf of a member. April 24, 2023. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. The site may also contain non-Medicare related information. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. hbbd```b``6O L %,"&*u`0;L:`5 ; 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. Your PCP will handle the prior authorization process. Explore the most popular historic site trails near Wetter with hand-curated trail maps and driving directions as well as detailed reviews and photos from hikers, campers and nature lovers like you. Our trusted community experts can give you the one-on-one help you need to shop for health insurance. At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. Step-by-Step Guide for Provider Finder. Whats new on the web? Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Your plan covers the items in the Drug List as long as you: To see your plan's Drug List, go toForms & Documents. Why participate? The next highest ascent for historic site trails is. To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section. Medicaid Providers: Updated Prior Authorization Tips and Peer - BCBSIL The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. 2 0 obj The table below contains some of the services covered under your plan. 3 0 obj MMAI and BCCHP Providers: Join Our Community Stakeholder Committee Use the links below to view BCBSIL and vendor guidelines that may apply. MMAI Plan Details | Blue Cross and Blue Shield of Illinois - BCBSIL We'd like to invite you to join us for our next committee meeting on May 18, 2023. Information on Service Authorization Disputes can be found on the Provider Service Authorization Dispute Resolution Request Form. How to File a Claims Dispute using Enterprise Appeals Application (EAA) Tracking ID 1. Sign up! Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. MCG (formerly Milliman Care Guidelines) is a trademark of MCG Health, LLC (part of the Hearst Health network), an independent third party vendor. These include prior authorization code lists with effective dates and related information for Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. This is the third stage of the varied WestfalenWanderWeg, which leads 216 km from Hattingen through the southern Ruhr area, the Paderborn region and the foothills of the Sauerland to Altenbeken in the Teutoburg Forest / Eggegebirge nature park. Refer to our Medicaid prior authorization summary for more details. Sometimes you may need to get approval from Blue Cross and Blue Shield of Illinois (BCBSIL) before we will cover certain inpatient, outpatient and home health care services and prescription drugs. The BCBSIL Provider Manuals are comprehensive guides for Blue Cross Community Health Plans SM, Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, Blue Cross Medicare Advantage (HMO) SM, Blue Cross Medicare Advantage (PPO) SM, Blue Choice PPO SM, HMO, PPO and Blue High Performance Network (Blue HPN ) EPO professional and facility providers. Registration is required. This step also helps you identify prior authorization requirements and utilization management vendors, if applicable. Sign up for theLifeTimes newsletterto get health and benefits articles delivered to your inbox every month. This step helps you confirm membership, coverage and other details, including prior authorization requirements and utilization management vendors. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. New User? Sara will be discussing Mental Health Awareness Month and cultural competency. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Our doctors and staff make decisions about your care based on need and benefits. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice, Have a prescription from your doctor for them, Fill the prescription at a network pharmacy. This trail is estimated to be 42.6 km long. x=r8?Qi xJI&JfIl3D:#SfAw $nb"n q~+|Vz?p~Q{vrle{{_F^gEx6,>/?e=kOws/nTgO~S>)ga0)D>Mx,lN}=v,QPD>j" The digital lookup tool is intended for reference purposes only. You also have the right to ask for a coverage decision. All Rights Reserved. For other services/members, BCBSIL has contracted witheviCore healthcare (eviCore)for utilization management and related services. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. The most popular and difficult historic site trail in Wetter is, RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, WestfalenWanderWeg Etappe 3: Wetter - Schwerte. Search for doctors, dentists, hospitals and other health care providers. For more information, refer to the 2021 Medicaid Prior Authorization Requirements Summary and 2021 Medicaid Prior Authorization Code List available in the Medicaid section on the Support Materials (Government Programs) page. Provider | Blue Cross and Blue Shield of Illinois - BCBSIL While not included in the digital lookup tool, some services always require prior authorization, such as inpatient facility admissions. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the members policy certificate and/or benefits booklet and or summary plan description. The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. Highlights: Our guest speaker is Sara Gray, Executive Director of National Alliance on Mental Illness, Kane-south, DeKalb and Kendall Counties. Utilization Management | Blue Cross and Blue Shield of Illinois - BCBSIL PDF Medicaid Prior Authorization Request Form - BCBSIL k+:6@1)^]WNQj sGG& hFa`@,%LFPBA7Xmxt$.=e0ne}#IoE 20iF 6Xg8Sf;+-P > For some services/members, prior authorization may be required through BCBSIL. Out-of-Network Coverage | Blue Cross and Blue Shield of Illinois - BCBSIL How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SMMake Decisions for Prior Authorizations? If you want to know more about the utilization management process or how decisions are made about your care, Contact Us. In addition, some sites may require you to agree to their terms of use and privacy policy. External link You are leaving this website/app (site). We are also the largest provider of health benefits in Illinois, serving more than 8.9 million members in all 102 counties across the state. Your feedback is vital to improving the care and services these members receive. When: Thursday, May 18, 2023, from 1 to 2:30 p.m. CST See Chapter 4 of theMember Handbookon the Forms & Documents page for more details. Out-of-Network Coverage. Please see Drug Information for more information. Reminder: Hospital 30-day Readmission Review Process for BCCHP and MMAI 4 0 obj 396 0 obj <>/Filter/FlateDecode/ID[<0A7FBF13C253BF478050EB5B54DA8A47><3D37E1700F053247902B206B607ACED5>]/Index[373 43]/Info 372 0 R/Length 112/Prev 171011/Root 374 0 R/Size 416/Type/XRef/W[1 3 1]>>stream The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. To see if you are eligible, Contact:Blue Cross and Blue Shield of Illinois' OTC vendor,Convey Health Solutions, at: 1-855-891-5274. Register Now. Those exceptions are: Emergency care or urgently needed care. Availity provides administrative services to BCBSIL. Grievance (Complaint) Appeals Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. PDF Medicare-Medicaid Alignment Initiative (MMAI) Demonstration Frequently Its a great chance to work with faith leaders, advocacy groups and other community-based organizations that support our members health and well-being. %PDF-1.7 BCBSIL makes no endorsement, representations or warranties regarding third-party vendors. The peer-to-peer discussion process is as follows: *Effective May 1, 2021, the only change is that providers can no longer submit clinicals for BCCHP members IN ADDITION TO doing a peer-to-peer call after the adverse determination. Where: Hybrid, Join us in person: You may be familiar with some of the Medicaid prior authorization resources on our Provider website. }&ji[@_{dsTchsqD7bL+x3AXG>z>(y{+/en6=V/e{.t&>jFj750hS) !yppH7edMUFA{u38_tZ'oKAlr, @qiD Blue Cross Community MMAI (Medicare-Medicaid Plan) SM Always check eligibility and benefits first through Availity or your preferred web vendor portal to confirm coverage and other important details, including prior authorization requirements and vendors, if applicable. Blue Cross Community MMAI has strict rules about how decisions are made about your care. You can find out if your drug has any added conditions or limits by looking at the Drug List. Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. Davis Vision is an independent company that has contracted with BCBSIL to provide vision benefits administration for government programs members with coverage through BCBSIL. stream Members should contact the vendor(s) directly with questions about the products or services offered by third parties. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice. Check out our Corporate Social Responsibility Reportto learn the ways we're serving our community. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. It also includes the drugs covered by Medicare Part D. As a member, you have no copay for covered items on the Drug List. Log In to the Shopping Cart, Need to Make a Payment? Whens the meeting for the next quarter? This approval is called "prior authorization." Register Now. Additional clinical information will not be reviewed by the utilization management team if the initial determination was an adverse determination due to failure to submit clinical information with the original request. At Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, we take great pride in ensuring that you receive the care you need. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Related Resources Drug Coverage. You also can call the MMAI plan's pharmacy help-line. One There are some exceptions when care you receive from an out-of-network provider will be covered. Welcome. When faxing prior authorization requests, you must use the Medicaid Prior Authorization Request Form. New User? *Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. But we know its nice to have other ways to view prior authorization information, too. eviCore healthcare (eviCore) is an independent company that has contracted with Blue Cross and Blue Shield of Illinois to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. Use Our New Prior Authorization Digital Lookup Tool for Medicaid Member Legal and Privacy To help ensure turnaround times are met and decisions are provided to requesting providers as quickly as possible, BCCHP and MMAI utilization management (UM) reviewers and medical directors are available seven days a week, excluding BCBSIL identified holidays. February 1, 2021 Blue Cross and Blue Shield of Illinois (BCBSIL) would like to outline important updates, tips and reminders on prior authorization processes for independently contracted providers treating our Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. Whats on the agenda? <> Who is responsible for getting the prior authorization? MMAI Medical Benefits | Blue Cross and Blue Shield of Illinois - BCBSIL Search your plan's drug list, find a pharmacy, and more. This is called prior authorization, preauthorization, pre-certification or prior approval. We're hosting quarterly Community Stakeholder Committee meetings to find ways to better serve our Blue Cross Community MMAI (Medicare-Medicaid Plan) SM and Blue Cross Community Health Plans SM (BCCHP) members. You are leaving this website/app ("site"). In addition, some sites may require you to agree to their terms of use and privacy policy. Most PDF readers are a free download. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Well also include reminders in the Blue Review. Luckily, your health insurance can change with you. You are leaving this website/app (site). How do I know if I need a prior authorization? Medical Benefits Blue Cross Community MMAI (Medicare-Medicaid Plan) SM covers many of your health care needs. Updated February 2021 1 Medicaid Prior Authorization Requirements Summary, Effective Jan. 1, 2021 (Updated February 2021) This information applies to Blue Cross Community MMAI (Medicare-Medicaid)SM and Blue Cross Community Health PlansSM (BCCHPSM) members. Prior Authorization Support Materials (Government Programs).