Outpatient Preauthorization Update for Phone System Users

June 29, 2012 

Earlier this year, updates that were made to the Blue Cross and Blue Shield of Illinois (BCBSIL) outpatient preauthorization automated phone line resulted in an inadvertent “looping” experience for some callers. 

To help lessen the impact of this situation in the short term, messaging has been added to help callers navigate the system. Additional upgrades are forthcoming; however, until they are deployed, the steps below must be taken to verify if preauthorization is needed for an outpatient service. (Please continue to follow your normal protocol for inpatient preauthorization.) 

In order to identify if an outpatient service requires preauthorization: 

  1. Obtain a quote of eligibility and benefits.
  2. Is preauthorization mentioned?

If not, then no preauthorization is required. If so, then once you’ve answered the faxback question you will be offered the opportunity to speak with a Customer Advocate. 

For an illustration of the automated phone system prompts related to obtaining this information, refer to the Outpatient Preauthorization Caller Guide.

Please note that the fact that a service has been preauthorized/pre-certified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.