Print

Attention Medicaid and MMAI Long-Term Care Providers: Custodial Care Services

Posted May 13, 2019

As a reminder, if you are a Long-Term Care Provider that is contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) to provide care and services to our Blue Cross Community Health PlansSM (BCCHPSM) and/or Blue Cross Community MMAI (Medicare-Medicaid)SM members, benefit prior authorization is not required prior to rendering custodial care services to Illinois Medicaid and MMAI members.

However, obtaining benefit prior authorization prior to rendering custodial care services to Illinois Medicaid and MMAI members is required when services are rendered by non-participating providers (i.e. providers that are not contracted with BCBSIL).

If you have any questions, please contact your assigned BCBSIL Provider Network Consultant.

Please note that 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.