Most PDF readers are a free download. Most PDF readers are a free download. The site may also contain non-Medicare related information. References to other third party sources or organizations are not a representation, warranty or endorsement of such organizations. Prior Authorization Doctors and Hospitals When choosing a doctor, make sure the doctor is part of the Blue Cross Community MMAI (Medicare-Medicaid Plan) SM network. Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. Drug Coverage. When faxing prior authorization requests, you must use the Medicaid Prior Authorization Request Form. 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. Availity provides administrative services to BCBSIL. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. Search your plan's drug list, find a pharmacy, and more. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. The most popular and difficult historic site trail in Wetter is, RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, WestfalenWanderWeg Etappe 3: Wetter - Schwerte. What is the longest historic site trail in Wetter? For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. Our doctors and staff make decisions about your care based on need and benefits. Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. External link You are leaving this website/app (site). Explore Out-of-Network Coverage for more information about your network. All Rights Reserved. Your PCP will handle the prior authorization process. To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. 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. To ask for instructions on how to appeal, call the Member Services line for the MMAI plan or call the Senior HelpLine and ask for the MMAI Ombudsman at 1-800-252-8966 (TTY users should call 1-888-206-1327) Monday-Friday 8:30 am-5pm. Our trusted community experts can give you the one-on-one help you need to shop for health insurance. This step helps you confirm membership, coverage and other details, including prior authorization requirements and utilization management vendors. 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. Your doctors will use other tools to check prior authorization needs. Medicaid Prior Authorization Request Form Please fax completed form to 312-233-4060 This information applies to Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. Check out our Corporate Social Responsibility Reportto learn the ways we're serving our community. 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. In addition, some sites may require you to agree to their terms of use and privacy policy. Copyright document.write(new Date().getFullYear()); Health Care Service Corporation. Non-Discrimination Notice. Well also include reminders in the Blue Review. If you have any questions, call the number on the member's BCBSIL ID card. Out-of-Network Coverage. You may be familiar with some of the Medicaid prior authorization resources on our Provider website. Santori Library 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. If you have a complaint about how we handle any services provided to you, you can file a grievance or an appeal. 4 0 obj Your plan does not encourage doctors to give less care than you need. Highlights: Our guest speaker is Sara Gray, Executive Director of National Alliance on Mental Illness, Kane-south, DeKalb and Kendall Counties. Registration is required. Certain drugs on the list need prior authorization. Most PDF readers are a free download. Most PDF readers are a free download. The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Checking eligibility and benefits through Availity Essential or your preferred web vendor is always the best place to start, before you provide care and services to any of our members. Without approval, the drug won't be covered. FIND YOUR WAY OUTSIDE is a trademark of AllTrails, LLC. April 24, 2023. 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 To view this file, you may need to install a PDF reader program. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. hbbd```b``nF`+d'lO0{d&WEV"8EVU9`"DaDa@6`4r lf|pwOIF@W; v#30^0 !X endstream endobj startxref 0 %%EOF 107 0 obj <>stream For some services/members, prior authorization may be required through BCBSIL. Log in to your account to get the most accurate, personalized search results based on your plan. You'll see details that may help lower health care costs. Home Our doctors and staff make decisions about your care based only on need and benefits. The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. Please note that, effective May 1, 2021, there will be a change to the BCCHP peer-to-peer discussion process, as specified below. Contact Us | Blue Cross and Blue Shield of Illinois Contact Us AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. % 0 *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. While not included in the digital lookup tool, some services always require prior authorization, such as inpatient facility admissions. Refer to our Medicaid prior authorization summary for more details. They use what is called clinical criteria to make sure you get the health care you need. File is in portable document format (PDF). Who is responsible for getting the prior authorization? %PDF-1.6 % Talk with your doctor about your medication. <> 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. Your PCP will handle the prior authorization process. Copyright 2021 Health Care Service Corporation. endobj Stay informed about BCBSIL programs, products, initiatives, and more. Your doctor will need to request approval before these drugs can be prescribed. 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. One option is Adobe Reader which has a built-in reader. MCG (formerly Milliman Care Guidelines) is a trademark of MCG Health, LLC (part of the Hearst Health network), an independent third party vendor. New to Blue Access for Members? The tool returns a list of services that may require prior authorization through BCBSIL or eviCore healthcare (eviCore) for BCCHP and MMAI members. %%EOF Renew Illinois Individual, Family & Medicaid Health Insurance, Blue Cross Community MMAI (Medicare-Medicaid Plan), Illinois Health Plan Tiered Prescription Drug Lists, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM The Centers for Medicare & Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement MMAI. See below for details, including the Zoom registration link. Whats new on the web? BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Providers are allowed the opportunity to schedule one peer-to-peer discussion per adverse determination. One The peer-to-peer discussion is available as a courtesy to providers. 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. The health of your eyes and teeth can affect your overall health. 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 <. If a request does not meet medical necessity criteria for approval, the request will be assigned to a BCBSIL medical director for determination. 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. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. eviCore healthcare manages all Inpatient Post-Acute Care (PAC) preauthorization requests for Blue Cross and Blue Shield of Illinois (BCBSIL) members enrolled in the following programs: Medicare Blue Cross Medicare Advantage (PPO)SM Medicaid Blue Cross Community MMAI (Medicare-Medicaid Plan)SM All Rights Reserved. Medical Policies are based on scientific and medical research. Your doctors will use other tools to check prior authorization needs. When: Thursday, May 18, 2023, from 1 to 2:30 p.m. CST Refer to important information for our linking policy. To support the decision process, BCBSIL gives providers the opportunity to discuss UM determinations with a peer physician. 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. Convey Health Solutions, Inc. is an independent company that provides administrative services for over-the-counter supplemental benefits for Blue Cross and Blue Shield of Illinois. How to request prior authorization: Prior authorization requests may be made by phone (call 877-860-2837 for BCCHP members, call 877-723-7702 for MMAI members) or by fax to 312-233-4060 (same fax number for BCCHP and MMAI).