The code lists are posted as PDFs so you can scroll through pages manually or enter to search, highlight and advance to all instances of a particular word or number. This step helps you confirm membership, coverage and other details, including prior authorization requirements and utilization management vendors. It will open in a new window. Medical policies are also used to guide care decisions. The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois (BCBSIL) government programs members enrolled in any of the following plans: 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. 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 If a request does not meet medical necessity criteria for approval, the request will be assigned to a BCBSIL medical director for determination. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Most PDF readers are a free download. Availity provides administrative services to BCBSIL. Welcome. During weekend hours, UM reviewers and medical directors continue to review requests and make decisions. The ASAM Criteria, 2021 American Society of Addiction Medicine. If you have any questions, call the number on the members ID card. endobj Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. BCBSIL adheres to the standards for addressing all urgent concurrent requests, meeting or exceeding National Committee for Quality Assurance (NCQA) standards. One option is Adobe Reader which has a built-in screen reader. New to Blue Access for Members? 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. Search articles and watch videos; ask questions and get answers. Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. BCBSIL makes no endorsement, representations or warranties regarding third-party vendors. 1 0 obj How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SMMake Decisions for Prior Authorizations? Sign up! This list includes generic and brand drugs and medical supplies. GDChv0O{Q~ $W0!&~(c~;=1^!GD=q2z5OR%AG.)H&lz'9|^f!(@.ib If you have a complaint about how we handle any services provided to you, you can file a grievance or an appeal. Medicaid Providers: Updated Prior Authorization Tips and Peer - BCBSIL 3 0 obj Medical Policies are based on scientific and medical research. Most PDF readers are a free download. See below for details, including the Zoom registration link. Prior Authorization Support Materials (Government Programs) - BCBSIL Blue Cross Community MMAI has strict rules about how decisions are made about your care. 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. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. This new site may be offered by a vendor or an independent third party. 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. Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. 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). Frequently asked questions about historic site trails in Wetter. *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. How to File a Claims Dispute using Enterprise Appeals Application (EAA) Tracking ID 1. One option is Adobe Reader which has a built-in reader. Our doctors and staff make decisions about your care based on need and benefits. One ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) endobj As you transition to Medicare, we hope you'll Stay with Blue and get Medicare coverage from a company you trust. All Rights Reserved. To support the decision process, BCBSIL gives providers the opportunity to discuss UM determinations with a peer physician. End along the Ruhr meadows over Lake Kemader to Lake Baldeney in Essen. The next highest ascent for historic site trails is. Most PDF readers are a free download. The site may also contain non-Medicare related information. This new site may be offered by a vendor or an independent third party. 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. Recently, we added a digital lookup tool that gives you a different way to view prior authorization requirements that may apply to our BCCHP and MMAI members. 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. Those exceptions are: Emergency care or urgently needed care. PDF Medicare-Medicaid Alignment Initiative (MMAI) Demonstration Frequently Limitations of Covered Benefits by Member Contract External link You are leaving this website/app (site). % To view this file, you may need to install a PDF reader program. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice. Most PDF readers are a free download. You are leaving this website/app ("site"). Drug Coverage. Providers are allowed the opportunity to schedule one peer-to-peer discussion per adverse determination. Your feedback is vital to improving the care and services these members receive. New User? For other services/members, BCBSIL has contracted witheviCore healthcare (eviCore)for utilization management and related services. From Siegen with the beautiful day ticket (33 euros for 5 people) to Wetter / Ruhr. Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. 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" 6C("=L,`YF'0 d Whens the meeting for the next quarter? If no clinical information was submitted with a request, a peer-to-peer discussion is not permitted. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com Doctors are not paid to deny care. option is Adobe Reader which has a built-in reader. 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 Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL What: Q2 2023 MMAI and BCCHP Community Stakeholder Committee Meeting Failing to provide clinical information or timely notification of prior authorization requests may affect the outcome of a Service Authorization Dispute. What is the most popular and difficult historic site trail in Wetter? Click here to see prior authorization tools, clinical review criteria and MMAI Medical Policies used by your doctor to make a decision. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. Prior Authorization Requirement Summaries, Code Lists and - BCBSIL Use the links below to view BCBSIL and vendor guidelines that may apply. 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. PDF Medicaid Prior Authorization Requirements Summary, Effective Jan. 1 At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. Why participate? One option is Adobe Reader which has a built-in reader. File is in portable document format (PDF). You may be familiar with some of the Medicaid prior authorization resources on our Provider website. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. To view this file, you may need to install a PDF reader program. Your doctor should know which services need approval and can help with the details. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. The Customer Service representative will provide you a reference number, which can be used to track the dispute. For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. Stage 3 of the long-distance hiking trail WestfalenWanderWeg, North Rhine-Westphalia. #5 - RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, #6 - WestfalenWanderWeg Etappe 3: Wetter - Schwerte. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider. How do I know if I need a prior authorization? Wetter - Kupferdreh Ruhrradweg | Map, Guide - North Rhine-Westphalia

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