BCBSIL Behavioral Health Preauthorizations for City of Chicago (CTY) Employees
Posted October 25, 2017
Blue Cross and Blue Shield of Illinois’ (BCBSIL) Provider Relations team is committed to helping you stay aware of changes and trends that may have an impact on your business. The City of Chicago (alpha prefix: CTY) has implemented changes for employees who are BCBSIL members that affect outpatient behavioral health and outpatient substance abuse services.
City of Chicago employees who receive outpatient behavioral health or outpatient substance abuse services are covered for up to seven visits in one year before utilization review is required. Members who have received seven outpatient services in one year will need prior authorization for additional visits, which providers can obtain by contacting the Medical Advisor, Telligen, prior to the eighth visit. Please note that the seven visits before prior authorization is needed per member, not per provider. Thus, if the member has received services from another behavioral health or substance abuse provider prior to coming to you for treatment, prior authorization may be needed before their initial visit with you.
You can reach Telligen at 800-373-3727, or visit their Provider Portal at telligen.qualitrac.com.
If you do not handle behavioral health preauthorizations, please forward a copy of this memo to the appropriate party. Questions may be directed to ProviderRelations@bcbsil.com, or by contacting your Provider Network Consultant. Services that are not preauthorized will not be paid by the plan and will be the financial responsibility of the provider. Members may not be charged for services that were not preauthorized.
BCBSIL cares about connecting behavioral health patients with an outpatient provider within 30 days of discharge from an inpatient stay. For more information about our visit the Behavioral Health Program page. The latest Health Care Effectiveness Data and Information Set (HEDIS®) results can be found in the Clinical Resources/Quality Improvement section, under HEDIS.
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).