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2019 Commercial PPO Benefit Preauthorization Requirements: New Tip Sheet

Posted February 21, 2019

In the fourth quarter of 2018, we posted a News and Updates notice to alert you of commercial benefit preauthorization requirement changes effective Jan. 1, 2019.

Benefit preauthorization for medical necessity under the applicable benefit plan for certain outpatient services aligns with our company’s commitment to help our members access the right care, at the right time, in the right setting.

We value the care and services you provide to our members. To help you navigate recent changes, we’ve prepared a one-page tip sheet that includes:

  • An overview of commercial PPO members who may be affected, and for which care categories/services.
  • Streamlined instructions on when and how to obtain benefit preauthorization through BCBSIL or eviCore healthcare (eviCore).
  • Other pre-service guidelines, important reminders, exceptions and links to helpful resources.

The 2019 Commercial Benefit Preauthorization Requirements Summary referenced above is available in the Related Resources on the Prior Authorization page. If you have questions, contact your assigned Provider Network Consultant (PNC). We’re here to help!

This information does not apply to HMO members.

Please note that the fact that a service has been preauthorized/pre-notified 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.

eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such eviCore. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.