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Fax Notification Process for Benefit Preauthorization and Predetermination of Benefits

Posted June 30, 2017

As always, we encourage you to take advantage of all available electronic options for increased administrative efficiencies. For example, iExchange® is our online tool that supports online submission and electronic approval of benefits for inpatient admissions, select outpatient and pharmacy services. iExchange accepts electronic medical record attachments when necessary in support of benefit preauthorization requests, and electronic medical record documentation may be submitted via this secure online tool for predetermination of benefit requests. iExchange also offers you an alternative to calling to request the status of your benefit preauthorization requests. For behavioral health services, you should use the current fax and telephone benefit preauthorization methods. 

If you are not using iExchange, please note that, beginning April 1, 2017, Blue Cross and Blue Shield of Illinois (BCBSIL) implemented a fax notification process to respond to benefit preauthorization and predetermination of benefits requests from providers. While notification letters will continue to be sent by mail to the address we have on file for you, the new fax process supports faster communication of information, reducing the need for providers to contact BCBSIL to check status while waiting to receive the mailed notification letters from BCBSIL. 

Fax notifications will be transmitted to the fax number we have on file for you, or the number listed on the utilization management, clinical request or other clinical documentation we received from you in conjunction with your benefit preauthorization or predetermination of benefits request. As a reminder, because confidential protected health information (PHI) may be sent to your office via fax, your fax machine should be in a secure location that is not accessible to those who do not have the authority to review member/patient PHI. 

If you do not wish to receive these faxed notifications, please contact your assigned BCBSIL Provider Network Consultant to discuss other options, such as utilizing iExchange to submit and check status of most benefit preauthorization/predetermination of benefits requests online.  

REMINDERS AND RESOURCES

  • Check eligibility and benefits first. To determine if a benefit preauthorization is needed, confirm member eligibility and benefits first through AvailityTM, or your preferred online vendor portal. Questions may be directed to the Customer Service number on the member’s ID card.
  • Learn more about iExchange. For more information about iExchange, including how to gain access if you are not a current user, visit the Education and Reference Center/Provider Tools section.
  • Attend a webinar. Training on iExchange and other topics is available. For webinar dates, times and online registration, visit the Webinars page in the Education and Reference Center.

Please note that checking eligibility and benefits and/or the fact that a service or treatment has been preauthorized or predetermined for benefits 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 questions, contact the number on the member’s ID card.

iExchange is a trademark of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Medecision. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.