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Reminder: Outpatient Molecular and Genomic Tests and Outpatient Radiation Therapy Benefit Preauthorization Requirements through eviCore

Posted December 1, 2016

Blue Cross and Blue Shield of Illinois (BCBSIL) has contracted with eviCore healthcare (eviCore) to provide benefit preauthorization services for Blue Choice PPOSM, Blue Choice Preferred PPOSM and PPO for select services including outpatient molecular and genomic tests and outpatient radiation therapy. Services performed without benefit preauthorization may be denied. 

When checking for eligibility and benefits for a member’s lab service or radiation therapy service on the AvailityTM Web Portal or by submitting an electronic eligibility and benefits inquiry (HIPAA 270 transaction) via Availity or your preferred vendor portal, a message will appear indicating eviCore may need to be contacted for benefit preauthorization. If eligibility and benefits are unable to be verified online, the same information is often readily accessible through the BCBSIL Interactive Voice Response (IVR) automated phone system. 

You will continue to use iExchange® for all other services that require a benefit preauthorization. 

Benefit preauthorizations for lab service or radiation therapy service may be obtained through the eviCore portal at eviCore.com or by calling eviCore toll-free at 855-252-1117, between 7 a.m. and 7 p.m. (CT), Monday through Friday. 

eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. 

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized 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. If you have any questions, please call the number on the member’s ID card.