October 27, 2020
On Oct. 1, 2020, we posted a News and Updates notice to alert you that the utilization management vendor that processes prior authorizations for some of our commercial members is changing. Starting Jan. 1, 2021, prior authorization requests for commercial Blue Cross and Blue Shield of Illinois (BCBSIL) members that are currently required to be submitted through eviCore healthcare (eviCore) will require prior authorization through AIM Specialty Health® (AIM).
This change will apply to some BCBSIL members with the commercial PPO products listed below:
- Blue Choice Preferred PPOSM
- Blue Choice PPOSM
- Blue OptionsSM/Blue Choice OptionsSM
- Blue High Performance NetworkSM (Blue HPNSM)
This change does not apply to any of our government programs/HMO members: HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, BlueCare DirectSM, Blue FocusCareSM, Blue Cross Community MMAI (Medicare-Medicaid Plan)SM, Blue Cross Community Health PlansSM (BCCHPSM), Blue Cross Medicare Advantage (HMO)SM or Blue Cross Medicare Advantage (PPO)SM.
Join Us for A Webinar to Prepare for the Transition
Visit the Webinars and Workshops page on our Provider website, or select your preferred date and time from the list below to sign up now:
There will also be a refresher/make-up session on Jan. 6, 2021 – 10 a.m. to noon.
Other Important Reminders
Make sure you’re registered with AIM, prior to Jan. 1, 2021. (If you’re already registered with AIM to submit Radiology Quality Initiative (RQI) requests for BCBSIL members, you don’t need to register again.) There are two ways to register:
- Online – Go to the AIM ProviderPortal ; or
- By Phone – Call the AIM Contact Center at 800-859-5299, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays.
Member benefits will vary based on the service being rendered and individual and group policy elections. Always check eligibility and benefits first, through the Availity® Provider Portal or your preferred web vendor, prior to rendering services. This step will help you confirm coverage and other important details, such as prior authorization requirements and vendors, if applicable. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
For More Information
Continue to watch the News and Updates for reminders, announcements and educational resources that will help you transition to submitting commercial prior authorization requests through AIM.
Checking eligibility and/or benefit information and/or the fact that prior authorization/pre-notification has been completed 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. Certain employer groups may require prior authorization/pre-notification through other vendors. If you have any questions, please call the number on the member's ID card.
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. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. 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 eviCore, AIM or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.