December 2, 2020
The City of Chicago will implement a change effective Jan. 1, 2021, for some of its employees with Blue Cross and Blue Shield of Illinois (BCBSIL) coverage, as noted below.
As of Jan. 1, 2021, required prior authorization requests for physical therapy services for City of Chicago employees with three-character BCBSIL member ID prefix CTY and group numbers 189421 and 189422 must be submitted through Telligen instead of OrthoNetTM.
Here are some keys points and reminders related to this change:
- Physical therapy services for these members must be certified to be medically necessary by Telligen.
- Claims submitted for physical therapy services without required prior authorization through Telligen may be denied.
- Prior authorization requests for physical therapy services for City of Chicago employees who are Blue Choice OptionsSM members must be submitted through Telligen after the seventh visit per benefit period (not per provider) with dates of service on or after Jan. 1, 2021.
Always check eligibility and benefits first 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.
Telligen is an independent company that provides Utilization Review/Case Management/Disease Management/Maternity Management to BCBSIL. Telligen is wholly responsible for its own products and services. OrthoNet is a registered trademark of OrthoNet LLC, an independent third party vendor that is solely responsible for its products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by independent companies/third party vendors, such as Telligen and OrthoNet. If you have any questions about the products or services they offer, you should contact the vendor(s) directly.
Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized, 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.