Support Materials (Commercial)
The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois (BCBSIL) commercial, non-HMO members.
Always check eligibility and benefits first through the Availity® or your preferred web vendor portal to confirm coverage and other important details, including prior authorization requirements and vendors, if applicable. For some services/members, prior authorization may be required through BCBSIL. For other services/members, BCBSIL has contracted with AIM Specialty HealthSM (AIM) for utilization management and related services. Here are some quick tips for using AIM.
The Requirements Summary below offers an overview with reminders and helpful links. Procedure code lists are included for reference purposes.
Commercial Prior Authorization Summary and Code Lists
- 2021 Commercial Prior Authorization Requirements Summary
- 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List
- 2021 Commercial Specialty Pharmacy Prior Authorization Drug List
- 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. 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 member’s policy certificate and/or benefits booklet and or summary plan description. 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. If you have any questions, call the number on the member's BCBSIL ID card.
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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity or AIM. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.