Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021
Posted December 15, 2020 (Updated December 31, 2020)
The phone number for prior authorization requests for inpatient, outpatient and specialty pharmacy service the members referenced below has been updated.
The Advocate Aurora Health Employee Benefit Plan will implement a utilization management change effective Jan. 1, 2021, for its employees and covered dependents with Blue Cross and Blue Shield of Illinois (BCBSIL) coverage. This change affects BCBSIL member ID prefix EAD and group numbers PI3844, PI3845 and PI3846.
For dates of service beginning Jan. 1, 2021:
- Required prior authorization requests for services for Advocate Aurora Health Benefit Plan members (BCBSIL member ID prefix EAD and group numbers PI3844, PI3845, PI3846) will no longer be handled by BCBSIL.
- Required prior authorization requests for inpatient, outpatient and specialty pharmacy services for these members must be submitted through Advocate Aurora Health instead of BCBSIL. (The phone number for prior authorization requests effective Jan.1, 2021, is 855-376-2386.)
- Required prior authorization requests for outpatient behavioral health disorders, behavioral illness and substance abuse services for these members must be submitted through AXCES Behavioral Health Advisor instead of BCBSIL. (The phone number for outpatient behavioral health prior authorization requests effective Jan. 1, 2021, is 800-454-6455.)
Important reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred web vendor for all BCBSIL members prior to rendering services. This step will help you confirm prior authorization requirements and utilization management vendors, if applicable. If you have any questions on benefits, refer to the member’s ID card for the appropriate contact information.
Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.
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.