Introducing a New Benefit Preauthorization Submission Tool via Availity Provider Portal
Posted Jan. 2, 2020
We’re excited to introduce a new online application for submission of electronic benefit preauthorization requests — Health Insurance Portability and Accountability Act of 1996 (HIPAA) 278 transactions — via the Availity Portal. This new tool — Availity Authorizations — will be available to you as of Jan. 30, 2020. It will offer more convenient functionality, making it faster and easier for you to submit and receive confirmation of online requests when benefit preauthorization through Blue Cross and Blue Shield of Illinois (BCBSIL) is required. For Federal Employee Program® (FEP®) members, you should continue using your current benefit preauthorization process until the new application becomes available in the near future.
What’s changing? What’s staying the same?
BCBSIL’s current electronic benefit preauthorization tool, iExchange®, will be deactivated on April 15, 2020. As of this date, all electronic benefit preauthorization requests handled by BCBSIL should be submitted using the new Availity Authorizations tool. This includes benefit preauthorization requests handled by BCBSIL for inpatient admissions, select outpatient services and behavioral health services.
The process of submitting benefit preauthorization requests through eviCore is not changing.
Medical and surgical predetermination of benefits requests should be submitted via fax or mail by using the Predetermination Request Form, along with the pertinent medical documentation.
What should you do to prepare?
During the transition period, you should migrate from iExchange to the new five-step Availity Authorization application. If you haven’t registered with Availity, you can sign up for free on the Availity website. For help, contact Availity Client Services at 1-800-282-4548.
How will the new tool work?
Submitting requests using the Availity Authorizations tool is easy and consists of only five steps:
- Log in to Availity
- Select the Patient Registration menu option, choose Authorizations & Referrals, then Authorizations
- Select Payer BCBSIL, then choose your organization
- Select Inpatient Authorization or Outpatient Authorization
- Review and submit your request
This new online option will also increase administrative efficiencies for your organization by allowing you to:
- Access and verify status of requests
- Upload clinical medical records
- Edit and/or extend requests
- Obtain printable confirmation numbers for your records
For More Information
Continue to watch for future News and Updates announcements and helpful resources, such as a new Availity Authorizations tip sheet, coming soon to the Provider Tools section of our website. If you need further assistance or customized training, contact our Provider Education Consultants.
The information in this notice does not apply to requests for HMO members.
Please note that the fact that a service has been preauthorized/pre-notified 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. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. eviCore is wholly responsible for its own products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, eviCore or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.