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Benefit Preauthorization Changes for Some Custom Accounts Will Take Effect Jan. 1, 2020

Posted October 2, 2019

Benefit preauthorization requirements are specific to the patient’s policy type and procedure(s) being rendered. It’s critical to check eligibility and benefits first for each member at every visit prior to rendering services. You may check eligibility and benefits by submitting an electronic 270 transaction via the Availity® Provider Portal or your preferred vendor portal. This step will help you determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details.

Effective Jan. 1, 2020, some Blue Cross and Blue Shield (BCBSIL) members with group coverage may need benefit preauthorization through eviCore healthcare (eviCore) for the following services:

  • Advanced Imaging
  • Cardiology
  • Genetic Testing
  • Joint and Spine Surgery
  • Pain Management
  • Radiation Therapy
  • Sleep Studies

See below for a list of three-character member ID prefixes for some of the members that may be affected by the change referenced above. This list is not all inclusive and there may be exceptions or additional changes. Always check eligibility and benefits first to confirm coverage, benefit preauthorization requirements and other important information prior to rendering services. Obtaining benefit preauthorization is not a substitute for checking eligibility and benefits.

ACX, PAS, V2T, VXJ, VXL, VXR, VXU, VXV, VYD

S3D, S3E, S3L, S3M, SFZ, SKK, VSN

UAL

There are two ways to obtain benefit preauthorization through eviCore:

  • Online – The eviCore web portal is the quickest way to initiate a case, check status, review guidelines and more.
  • By phone – Call eviCore at 855-252-1117 between 7 a.m. and 7 p.m. (CT), Monday through Friday.

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, contact the number on the member’s ID card.

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.

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. 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 as Availity or eviCore. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.