Behavioral Health Care Management Program



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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.




Health Care Service Corporation, Inc. (operating through its four division; BCBS of Illinois, BCBS of New Mexico, BCBS of Oklahoma, and BCBS of Texas) Behavioral Health Care Management program was accredited for Health Utilization Management in October of 2012.

 

URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC strives to ensure that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org.


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:

 

 Phone:

 PPO: 800-851-7498

 FEP: 800-779-4602

 Fax:

 877-361-7656

 Mail:

 BCBSIL BH Unit, PO Box 660240, Dallas, TX  75266-0240

 

How to contact the BCBSIL MMAI ICP Behavioral Health Unit:

 

 Phone:

 MMAI: 877-723-7702

 ICP: 888-657-1211

 Fax:

 312-233-4060

 Mail:

 BCBSIL MMAI ICP BH Unit, PO Box 660103, Dallas, TX  75266

 


  • 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.

*This secure content is password protected. Refer to the "Instructions for PPO and BlueChoice Select Providers" on the Secure Content Welcome page for details.

All behavioral health benefits are subject to the terms and conditions as listed in the member’s benefit plan.