May 26, 2021
Earlier this year, the Advocate Aurora Health Employee Benefit Plan made some prior authorization-related changes for its employees and covered dependents with Blue Cross and Blue Shield of Illinois (BCBSIL) coverage. The BCBSIL ID card for Advocate Aurora Health members shows three-character prefix EAD and group numbers PI3844, PI3845, PI3846. To alert you of changes affecting these members, previous communications included information on utilization management vendor changes (effective Jan.1, 2021) and a list of care categories for procedures that may require prior authorization (effective April 1, 2021).
Please note that, for Advocate Aurora Health members, the list of care categories for procedures that may require prior authorization has been updated. One new prior authorization care category (Infertility) has been added, with an effective date of Sept. 1, 2021. See below for the updated list and related information.
Advocate Aurora Health Prior Authorization Requirements (Summary)
Prior authorization for the following care categories/procedures may be required for BCBSIL members with ID prefix EAD and group numbers PI3844, PI3845 and PI3846:
- Advanced Imaging
- Ambulatory/Outpatient Surgery
- Behavioral Health Services
- Durable Medical Equipment (DME)/Disposable Supplies
- Elective Inpatient Medical/Surgical
- Infertility (effective Sept. 1, 2021)
- Joint/Spine Surgery
- Molecular and Genetic Lab
- Outpatient Rehab Services
- Outpatient Services
- Pain Management
- Post-acute Care
- Radiation Oncology
- Sleep Medicine/Sleep Surgery
- Specialty Pharmacy
How to Submit Prior Authorization Requests for Advocate Aurora Health Members
- For inpatient, outpatient and specialty pharmacy services, required prior authorization requests must be submitted through Advocate Aurora Health. The phone number for prior authorization requests is 312-808-5509.
- For outpatient behavioral health disorders, behavioral illness and substance abuse services, required prior authorization requests must be submitted through AXCES Behavioral Health Advisor instead of BCBSIL. The phone number for outpatient behavioral health prior authorization requests is 800-454-6455.
Other Important Reminders
Prior authorization requirements are specific to the patient’s policy type and procedures(s) being rendered. Always check eligibility and benefits for each member prior to rendering services, through the Availity® Provider Portal or your preferred web vendor. This step will confirm membership and other important details, such as prior authorization requirements and utilization management vendors, if applicable. Services performed with required prior authorization may be denied for payment and providers may not seek reimbursement form BCBSIL members. If you have any questions, call the number on the member’s ID card.
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment. Payment is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations and exclusions set forth in your patient’s policy certificate and/or benefits booklet and/or summary plan description. Regardless of any benefit determination, the final decision regarding any treatment or service is between you and your patient. 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. 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.