Fertility Services for OSF Healthcare Members: New Prior Authorization Requirement, Effective Jan. 1, 2022

October 1, 2021

Effective Jan. 1, 2022, prior authorization will be required prior to rendering fertility services for Blue Cross and Blue Shield of Illinois (BCBSIL) members with OSF Healthcare group coverage. Claims submitted for these services without prior authorization may be denied.

To identify OSF Healthcare members, look for the following three-character prefix on the member’s BCBSIL ID card: E6F. Group numbers are 280541, 280542, 280805, 280808.

Fertility services rendered without prior authorization for OSF Healthcare members will not be paid and will be the financial responsibility of the provider – members may not be charged for these services.

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 without 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 or pre-notification is not a guarantee of payment of benefits. Payment of benefits 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 the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.

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.