August 3, 2023
Blue Cross and Blue Shield of Illinois (BCBSIL) is continuing to make enhancements to its Behavioral Health (BH) pre-service request and review process for some commercial members.
When submitting pre-service review requests for BH services, the best method is to submit your request electronically using our BlueApprovRSM tool. BlueApprovR is accessible through Availity® Essentials and is quick and easy to use – more than 80 percent of requests for Behavioral Health services are approved right away. (Not registered for Availity? Sign up online today at no cost at Availity.com.)
Here’s what’s new, effective Nov. 1, 2023, if you’re unable to submit a request electronically through BlueApprovR: When you call the number on the member’s ID card and use our interactive voice response (IVR) system, you’ll be directed to Customer Service and a live clinician for a real-time review, instead of waiting for a call back.
Note: Beginning Nov. 1, 2023, certain outpatient services will no longer be requested by form, including Intensive Outpatient Program (IOP), Electroconvulsive Therapy (ECT), and Repetitive Transcranial Magnetic Stimulation (TMS). Effective Nov. 1, 2023, these requests can be submitted online using our BlueApprovR tool or by phone using the new live review process described above.
Continue to watch News and Updates for more information on Behavioral Health.
Remember: Always check eligibility and benefits first through Availity or your preferred web vendor. This step confirms important details, including prior authorization requirements and utilization management vendors, if applicable.
These Behavioral Health changes do not apply to Medicare Advantage or Illinois Medicaid 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. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.