Reminder of 2019 Benefit Preauthorization Changes (Commercial)

Posted December 21, 2018

As we head into 2019 we want to thank you for making 2018 a healthier year for so many of our members. We want to take this time to remind you of some important changes that will become effective Jan. 1, 2019.

As announced previously, Blue Cross and Blue Shield of Illinois (BCBSIL) will expand its benefit preauthorization requirements for certain outpatient services for some commercial members, effective Jan. 1, 2019. These changes may mean you need to obtain benefit preauthorization through eviCore for the following care categories:

  • Advanced Imaging 
  • Musculoskeletal (includes joint and spine surgery) 
  • Pain Management 

Other Important Reminders and Resources

  • Benefit preauthorization/pre-notification through BCBSIL will continue to be required for some services/care categories. For benefit preauthorization through BCBSIL, we encourage you to use our online tool, iExchange®.
  • The AIM Specialty Health® prenotification process will continue for members that are not required to have preauthorization through eviCore for Advanced Imaging.  You should continue to contact AIM, as you have done in the past for Radiology Quality Initiative (RQI) services.
  • Always check eligibility and benefits first. Submit online eligibility and benefits requests (electronic 270 transactions) via the Availity® Provider Portal or your preferred web vendor portal. This step will also identify benefit preauthorization/pre-notification requirements and specify utilization management vendors that must be used, if applicable.
  • Learn more about iExchange and Availity. Join BCBSIL for an iExchange webinar to learn how to access and navigate our online benefit preauthorization tool. Also sign up for a BCBSIL Back to Basics: ‘Availity 101’ webinar for an overview of eligibility and benefits and other electronic transactions that may be conducted via the Availity Portal. For dates, times and online registration links, visit the Webinars page.
  • Stay informed. Continue to watch the  News and Updates for announcements and helpful resources.

eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. iExchange is a trademark of Medecision, Inc. (Medecision), a separate company that provides collaborative health care management solutions for payers and providers. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM, Medecision or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. 

Checking eligibility and benefits and/or obtaining preauthorization/pre-notification or an RQI for a service is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider. If you have any questions, please call the number on the member's BCBSIL ID card.