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Participating Providers are Responsible for Obtaining Inpatient Benefit Preauthorization for Blue Cross and Blue Shield Members

Posted June 29, 2018

As a reminder, participating providers are responsible for obtaining applicable benefit preauthorization as required prior to rendering inpatient services for Blue Cross and Blue Shield members. Services performed without first obtaining applicable benefit preauthorization as required may be denied in whole or in part for payment and you may not seek any reimbursement from the member. For any service not approved for payment, all appropriate appeal rights will be provided by the health plan for review. Requesting benefit preauthorization is not a substitute for checking eligibility and benefits.

For additional information related to Blue Cross and Blue Shield of Illinois (BCBSIL) members, refer to the Prior Authorization page.

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. Exceptions may apply. If you have any questions, call the number on the member’s ID card.