February 25, 2020
This communication has been updated as, since the launch of the Availity Authorizations tool on Feb. 17, 2020, behavioral health services have been added as an exclusion. As noted below, please continue using your current benefit preauthorization process for behavioral health services until this functionality becomes available in the near future.
This is a follow-up to a previous notice regarding delayed implementation of the new Availity Authorizations tool, which was originally scheduled to launch in late January 2020.
We’re pleased to announce that the Availity Authorizations tool (HIPAA-standard 278 transaction) is available as of Feb. 17, 2020, for submission of benefit preauthorization requests handled by Blue Cross and Blue Shield of Illinois (BCBSIL). This includes benefit preauthorization requests for inpatient admissions and select outpatient services. For benefit preauthorization requests for behavioral health services, as well as benefit preauthorization requests for Federal Employee Program® (FEP®) members, you should continue using your current benefit preauthorization process until this new tool becomes available in the near future.
- If you haven’t registered with Availity, you can sign up for free on the Availity website. For help, contact Availity Client Services at 800-282-4548.
- Our current electronic benefit preauthorization submission 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 Availity Authorizations tool.
- The process of submitting benefit preauthorization requests through eviCore healthcare (eviCore) or other vendors is not changing.
- Medical and surgical predetermination of benefits requests should be submitted via fax or mail using the Predetermination Request Form, along with the pertinent medical documentation.
Training and Support
We are hosting additional Availity Authorizations training webinars for you to learn how to use this new tool. Select the link below for your preferred date and time to register.
If you have questions or need customized training: Contact our Provider Education Consultants.
The information in this notice does not apply to benefit preauthorization 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.