January 31, 2023
BlueApprovR is a new tool that helps simplify and expedite the process for prior authorization requests handled by Blue Cross and Blue Shield of Illinois (BCBSIL).
We launched BlueApprovR in November 2022 for online submission of prior authorization requests for some behavioral health services and specialty pharmacy drugs for many of our commercial, non-HMO members. We’ll soon be expanding this tool to handle additional types of prior authorization requests for these members.
Remember: For some services, prior authorization may be handled by a utilization management vendor, such as AIM Specialty Health® (AIM), rather than BCBSIL. When you check eligibility and benefits to confirm membership, you'll be advised of prior authorization requirements and utilization management vendors, if applicable.
Why use BlueApprovR?
BlueApprovR is an intuitive tool that fits right into your daily workflow. Here's a summary of how it works and what this tool offers to you and your staff:
- Easy access – You can launch BlueApprovR via a single sign-on process via the Availity® Essentials portal – no need to log on to a separate vendor site. It's free and available 24/7 for registered Availity users. For more information about how to gain access via Availity, visit our BlueApprovR page for a helpful user guide.
- A personalized experience – BlueApprovR has user friendly features to make the process efficient, but also enjoyable. Choose an avatar – the system remembers you the next time you log on.
- Simple navigation – The tool gives you step-by-step prompts to follow. Just answer a minimum number of questions, specific to your request.
- Option to upload attachments – You'll get an alert message if documentation is required to process your request. You can attach the necessary files (PDF or TIF), just like you would add attachments to an email, and submit them to BCBSIL on the spot.
- Check details – You'll get a summary page to double check your information. You can make edits as needed, then submit the request.
- Quick results – You'll get an answer from BCBSIL within minutes. BlueApprovR returns a certificate number and patient information. (You'll also get a letter in the mail in three to five days with the same information, but you don't need to wait for the letter to proceed with care.)
- Option to print or save – Just go to your BlueApprovR homepage to download or print a summary of what's been approved so you can save it in the patient's record for future reference.
What are providers saying about BlueApprovR?
During our introductory webinars, we asked participants how BlueApprovR compares to previous processes. Here’s a summary of comments we’ve received: It's quicker and more user friendly, with less questions and information to fill out. The ability to submit a request and get a response from BCBSIL while the patient is still in the office makes a huge difference.
Find Out What’s New: Join Us for a Webinar
Feb. 1, 2023 – 11 a.m. to noon
Feb. 8, 2023 – 11 a.m. to noon
Feb. 15, 2023 – 11 a.m. to noon
You don't have to be a current Availity user to attend a webinar, but you must be registered with Availity to gain access to BlueApprovR. Not a registered Availity user? Go to the Availity website to register online, at no cost. If you need help with Availity registration, call Availity Client Services at 800-282-4548.
Other Reminders and Resources
Always check eligibility and benefits first via Availity or your preferred web vendor, prior to rendering care and services. This step confirms membership and other important information, including prior authorization requirements and utilization management vendors, if applicable.
For prior authorization code lists and a digital lookup tool, go to the Prior Authorization Support Materials (Commercial) page in our Utilization Management section.
Even if prior authorization isn't required, you may want to submit an optional request to BCBSIL for recommended clinical review (formerly called predetermination). See our Medical Policy Reference List for details.
We Want To Be Your Payer of Choice
We appreciate the care and services you provide to our members. We value your time, and we want to make it easier for you to do business with us. In addition to BlueApprovR, we offer and support a suite of electronic tools and resources for contracted providers. Please refer to our Provider Tools page for a menu of options. Also see our Electronic Commerce page for an overview of electronic transactions and how to get started. Questions? Email your assigned BCBSIL Provider Network Consultant.
*BlueApprovR isn't available for prior authorization requests for government programs (Medicare Advantage or Illinois Medicaid) or any of our HMO members.
Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations 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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.