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Benefit Preauthorization for Fertility Services for Some Members Must Be Obtained Through WINFertility, Effective Jan. 1, 2020

Posted October 2, 2019

Effective Jan. 1, 2020, obtaining benefit preauthorization through WINFertility will be required prior to rendering fertility services for some Blue Cross and Blue Shield (BCBSIL) members with group coverage. See below for a list of three-character member ID prefixes for members in two groups who may be affected by this change.*

FWA, FWB, FWD, JNW, KWE, KWR, NYW, W2M, W3M, W5M, WAG

ELM, LDC, LSJ, S2E, S2F, SKY, STX

 

To obtain benefit preauthorzation online through WINFertility for these members, you may use the WINFertility Provider Portal. For assistance, email WINFertility at ProviderRelations@winfertility.com.

Benefit preauthorization information also may be obtained by calling the number on the member’s ID card.

Services performed without required benefit preauthorization will be denied for payment and providers may not seek reimbursement from BCBSIL members. If you have any questions, call the number on the member’s ID card.

Important reminder: Always check eligibility and benefits first for each member at every visit prior to rendering services. You may check eligibility and benefits electronically by submitting an electronic 270 transaction via the Availity® Provider Portal or your preferred vendor portal. This step may help you determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details. Obtaining benefit preauthorization is not a substitute for checking eligibility and benefits.

*This list is not all-inclusive. The information is subject to change and there may be exceptions. Check eligibility and benefits.

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

WINFertility is an independent company that provides fertility management solutions for BCBSIL. WINFertility is solely responsible for the products and services that it provides. 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. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party companies such as WINFertility or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.