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Extending Prior Authorization on Previously-Approved Elective Surgeries, Procedures and Therapies

Posted April 6, 2020 (Updated)

Please Note: Additional updates have been made to the prior authorization accommodation on May 14, 2020. Learn more.

Blue Cross and Blue Shield of Illinois (BCBSIL) is temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1, 2020 and April 1, 2020. The extension is for certain non-emergent, elective surgeries, procedures, therapies and home visits.

A member may reschedule an approved procedure to a later date in 2020 without requiring a new prior authorization. This applies only to current members for a benefit that is covered under their plan at the time services are rendered. Check member eligibility and benefits through Availity® or your preferred vendor web portal prior to the scheduled procedure. Eligibility and benefit quotes include membership status, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts.

Details

  • BCBSIL will honor all prior authorizations on non-emergent surgeries, procedures, therapies and home visits approved or scheduled between Jan. 1, 2020 and April 1, 2020.
  • These prior authorizations are approved through December 31, 2020, so approved procedures can be rescheduled any time before Dec. 31, 2020.
  • Therapy sessions and home visits authorized for a specific number of occurrences between Jan. 1, 2020 and April 1, 2020 will have the same number of occurrences available through Dec. 31, 2020.
  • These rules apply to current members for a benefit that is currently covered under their plan.

Is this for all members?
This extension applies to all group, fully-insured, retail, self-funded (PPO and Blue Choice PPOSM), and Medicare Advantage members. It does not apply to HMO members.

BCBSIL will continue to follow guidance from the Illinois Department of Healthcare and Family Services (HFS) and Centers for Medicare & Medicaid Services (CMS) with regard to benefit prior authorizations for Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM plans.

Excluded Prior Authorizations
Prior authorizations for specialty medications are not extended. Providers must submit a new request for specialty medications.

How are prior authorizations extended?
Prior authorizations are automatically extended. Providers do not need to do anything additional.

Additional Services or Sessions
For additional services or sessions, providers must submit a new prior authorization request.

Checking eligibility and/or benefit information 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, please 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. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.