Behavioral Health Care Management Program
Blue Cross and Blue Shield of Illinois (BCBSIL) manages behavioral health services for all non-HMO members who have behavioral health benefits through BCBSIL.
For HMO members, behavioral health services are managed by the member’s MG/IPA. Substance abuse continues to be administered by Magellan.
Behavioral health care management is integrated with our medical care management program, as part of Blue Care Connection® (BCC), 
to help members access their behavioral health benefits and to improve coordination of care between medical and behavioral health providers. This program will help BCBSIL clinical staff identify members who could benefit from co-management earlier, and may result in:
- Improved outcomes
- Enhanced continuity of care
- Greater clinical efficiencies
- Reduced costs over time
Some members* may be referred to other BCC medical care management programs that are designed to help identify and help close potential gaps in care through evidence-based and member-focused approaches to health care and benefit decisions.
All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan.
* Members experiencing inpatient hospitalization, complex or special health care needs or who are at risk for medical complications may be referred to BCC programs through a variety of mechanisms such as predictive modeling, claim utilization, inbound calls, self-referrals and physician referrals. If members do not have BCC as part of their group health plans, they will not be referred to other BCC programs.
Members are responsible for requesting preauthorization when preauthorization is required. Behavioral health providers or a member’s family member may request preauthorization on behalf of the member. All services must be medically necessary.
Inpatient and Alternative Levels of Care
Preauthorization is required for all inpatient, residential treatment center (RTC) and partial hospitalization admissions.
- Elective or non-emergency hospital admissions must be preauthorized prior to admission or within two business days of an emergency admission.
- To determine if RTC services are covered and to obtain authorization, call the appropriate number on the back of the member’s ID card.
- Partial Hospital Program (PHP)
Outpatient
These outpatient services require preauthorization:
- Electroconvulsive therapy (ECT)
- Psychological testing
- Neuropsychological testing
- Partial Hospital Program (PHP)
- Intensive Outpatient Program (IOP)
Members are responsible for requesting preauthorization when preauthorization is required, although behavioral health providers or a member’s family member may request preauthorization on behalf of the member. All services must be medically necessary.
Inpatient and Alternative Levels of Care
Call the appropriate number on the back of the member’s ID card.
Outpatient
Members should call the behavioral health number on the back of their ID card.
Behavioral health professionals and physicians or the patient’s family, acting on behalf of the member, may call to request preauthorization.
Inpatient and Alternative Levels of Care
Members who do not request preauthorization for inpatient and alternative levels of care behavioral health treatment may experience the same benefit reductions that apply to inpatient medical services. Medically unnecessary claims will not be reimbursed.
Outpatient
If a member receives any of the behavioral health services listed below without preauthorization, BCBSIL will request clinical information from the provider for a medical necessity review. The member will also receive notification.
- Electroconvulsive therapy (ECT)
- Psychological testing
- Neuropsychological testing
- Partial Hospital Program (PHP)
- Intensive Outpatient Program (IOP)
How to contact the BCBSIL Behavioral Health Unit:
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Phone: |
Call the appropriate number on the back of the member’s ID card. |
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Fax: |
877-361-7656 |
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Mail: |
BCBSIL BH Unit, PO Box 660240, Dallas, TX 75266-0240 |
- Information on the Behavioral Health Care Management Program is located in the BCBSIL Provider Manual, in the Product Information section under Medical Management.*
- If you have any questions, please contact your assigned Provider Network Consultant.
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