2021 Commercial Procedure Code List - Fully Insured - Predetermination, Medical Necessity and Non-Covered Services.2022 Commercial Procedure Code List - Fully Insured - Predetermination, Medical Necessity and Non-Covered Services.2023 Commercial Procedure Code List - Fully Insured - Recommended Clinical Review (Predetermination), Medical Necessity and Non-Covered Services.Predetermination, Post-Service Review and Non-Covered Code List
2021 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code List.2021 Commercial Outpatient Benefit Preauthorization Behavioral Health Procedure Code List for FI & ASO members.2021 Prior Authorization Requirements - Summary of Services.2022 Commercial Specialty Pharmacy Prior Authorization Drug List.2022 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List.2022 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code.2022 Commercial Outpatient Benefit Preauthorization Behavioral Health Procedure Code List.2022 Prior Authorization Requirements - Summary of Services.2023 Commercial Specialty Pharmacy Prior Authorization Drug List.2023 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List.2023 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code List.
2023 Commercial Outpatient Benefit Preauthorization Behavorial Health Procedure Code List.2023 Prior Authorization Requirements - Summary of Services.Review categories below to find out if a member's procedure may require prior authorization. Lists are updated quarterly to comply with AMA and CMS guidelines.Ĭonsult Availity ® or your preferred vendor for eligibility and benefits.ĭigital Lookup Tool (For Fully Insured Only) These lists are not exhaustive and are not necessarily covered under the member benefits contract. To register, visit the Webinars and Workshops page.The procedures or services on these lists may require prior authorization by BCBSOK, eviCore Healthcare ® (for Blue Cross Medicare Advantage SM Members) or Carelon Medical Benefits Management (formerly known as AIM Specialty Health) for some commercial members. (CT),Ĭomplimentary training for PPO providers, billing services, clinical and administrative staff who are new or already participating in the BCBSIL network If you do not have online access, use our automated phone system for eligibility and benefits and other self-service requests View Provider Network Consultant Assignments
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Our PNCs can offer information on how to use online tools, BCBSIL products and initiatives, provider education opportunities and personalized office visits. Government Provider Network Services Hotlinesīlue Cross Community Health Plans SM (BCCHP SM)īlue Cross Community MMAI (Medicare-Medicaid Plan) SMīlue Cross Medicare Advantage SM (HMO and PPO) Report concerns to the BCBSIL Special Investigations Department (SID) Verify eligibility and benefits and/or check claim status for FEP members Obtain benefit preauthorization for certain care categories Register with Availity Essentials to verify eligibility and benefits, submit benefit preauthorization requests, obtain claim status, view provider claim summaries and moreĬlient Services: 1-800-AVAILITY (282-4548)Ĭall for out-of-state member eligibility and benefits Obtain or confirm a patient’s Radiology Quality Initiative (RQI) number
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