Prior Authorizations - Provider Preauthorization for ... If you do not have Adobe ® Reader ®, download it free of charge at Adobe's site.. Types of Forms It will open in a new window. Medical Specialty Drugs list (For Commercial, Exchange, Medicare, Essential Plan, Medicaid, Child Health Plus)- November 1, 2021 Open a PDF; Drug Prior Authorization Fax forms GENERAL INFORMATION Patient Name Request Type (please check one) BCBS Provider Phone Number - Anthem Blue Cross and Blue ... Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. Enrollment in Blue Shield of California depends on contract renewal. Utilization Management - BCBSIL Forms. Prior authorization requests for the following services are reviewed by our partners. Submit an electronic prior authorization request. A prior authorization is not a guarantee of . 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List PROCEDURES REQUIRING PRIOR AUTHORIZATION EXCEPT AS OTHERWISE NOTED IN THE UPDATES COLUMN, THESE PRIOR AUTHORIZATION REQUIREMENTS ARE EFFECTIVE Always check eligibility and benefits first through the Availity ® or your preferred web vendor portal to confirm coverage and other important details . You can also check the status of your authorization by contacting the phone number on the back of your ID card. Prior Authorization Requirements | California Provider ... Effective March 1, 2020, some Blue Cross and Blue Shield of Illinois (BCBSIL) members in Texas will have new prior authorization requirements through eviCore healthcare (eviCore)®. Utilization Management. Blue Shield of California is an HMO and PDP plan with a Medicare contract. Prior Authorization Changes for Certain BCBSIL Members in Texas. Request Authorization | Providers - Excellus BCBS Contact Us - Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., comply with applicable federal civil rights laws and do not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex. (RQI) number. Utilization Management - Blue Cross and Blue Shield of ... United States List BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) . The form number and most recent revision date are displayed in the top left corner. This includes: National Imaging Association (NIA) manages prior authorization for MRI, PET, CT scans, nuclear cardiology, and radiation oncology procedures. Availity's Authorizations tool (HIPAA-standard 278 transaction) allows the electronic submission of inpatient admissions, select outpatient, select office and behavioral health services handled by BCBSIL. Helps lower your overall medical costs and maximizes your coverage within your benefits. Call Member Services at (800) 776-4466 [TTY: 711] for more information. Box 660027 Dallas, TX 75266-0027. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey's Health Insurance Marketplace. The forms in this online library are updated frequently—check often to ensure you are using the most current versions.Some of these documents are available as PDF files. Prior authorization is required for some members/services/drugs before services are rendered to confirm medical necessity as defined by the member's health benefit plan. University of Texas (UT Select) aimspecialtyhealth.com . Providers can call toll-free at 1-855-252-1117. Fax: 877-361-7656. Prior authorization (sometimes called preauthorization or pre-certification) is a pre-service utilization management review. The Department of Insurance may update this form periodically. The forms in this online library are updated frequently—check often to ensure you are using the most current versions.Some of these documents are available as PDF files. Types of utilization management review that may be conducted before services are rendered include prior authorization, predetermination and pre-notification. When you know what steps you need to take before treatment, things go more smoothly.One of the most important steps is prior authorization.. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. Effective May 1, 2019, Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) providers are required to use the Availity® Provider Portal to submit preservice prior authorization requests. Many times, your doctor will need to get approval - prior authorization - before your plan will cover certain health care services and medicines. 06/30/21 New Illinois Uniform Electronic Prior Authorization Form For Prescription Benefits 06/30/21 Government Programs Prior Authorization Update: Code Changes, Effective Oct. 1, 2021 06/29/21 Closing Gaps in Care for Group Medicare Advantage (MA) Members Print Prior Authorization Support Materials (Commercial) The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois (BCBSIL) commercial non-HMO fully insured members. Fax: 866-589-8254. Members. Forms. Services requiring prior authorization through eviCore®: Visit the eviCore Healthcare Web Portal. 5-2016) SUBMISSION INSTRUCTIONS GENERAL PRESCRIPTION DRUG COVERAGE AUTHORIZATION REQUEST FORM This form is for authorization of prescription drug benefits only and must be COMPLETELY filled out. BCBSIL, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Understanding your health insurance is the best way to enjoy all its benefits. An Independent Licensee of the Blue Cross and Blue Shield Association MKT-148 (Rev. Your doctor must contact Florida Blue at 1-877-719-2583 or its delegate at (800) 424-4947 at MagellanRx Management. This link will take you to a new site not affiliated with BCBSIL. Your health care provider can use any of the following ways to request prior review and certification: By phone: Blue Cross NC Utilization Management at 1-800-672-7897 Monday to Friday, 8 a.m. — 5 p.m. Submit online at National Imaging Associates or call 1-800-642-7820 . Utilization management review requirements and recommendations are in place to help ensure our members get the right care, at the right time, in the right setting. Contact Information for Blue Cross and Blue Shield of Illinois. Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our . The Formulary, pharmacy network, and/or provider network may change at . 215 ILCS 5/364.3 requires the use of a uniform electronic prior authorization form when a policy, certificate or contract requires prior authorization for prescription drug benefits. Availity's Authorizations & Referrals tool (HIPAA-standard 278 transaction) allows the electronic submission of inpatient admissions, select outpatient services and referral requests managed by BCBSTX Medical Management. By fax: Request form. Prior authorization of Medical Services for the Health Insurance Marketplace for Blue Advantage HMO Members. 855-462-1785. Types of utilization management review that may be conducted before services are rendered include prior authorization, predetermination and pre-notification. Fax: 866-589-8253. The members affected have the following three-character prefixes in front of their ID number: For Medical Specialty Drug Unit, call: 1-800-306-0151, or fax: 1-800-306-0188. If you do not have Adobe ® Reader ®, download it free of charge at Adobe's site.. Types of Forms Blue Cross Blue Shield of Texas Medical Care Management P. O. This information is not a complete description of benefits. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Refer to the Behavioral Health page for additional information. For prior authorization requests handled by AIM Specialty HealthSM (AIM): Submit your request to AIM in one of the following ways: Online - The AIM ProviderPortal is available 24x7. If you have questions or concerns regarding these programs, please call Prime Therapeutics at 800-285-9426. Or, download ST program criteria summaries and fax forms from the Prime Therapeutics website using the following link: Step Therapy Program Criteria Summary and Fax Form List. Utilization Management. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. How. ET. Services requiring prior authorization through Magellan Healthcare®: Call the number on the back of the member's ID card. BCBSIL BH Unit PO Box 660240 Utilization management review requirements and recommendations are in place to help ensure our members get the right care, at the right time, in the right setting. Additionally, providers can also check status on previously submitted requests and/or update applicable existing requests. Prior Authorization Health insurance can be complicated—especially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). This website does not display all Qualified Health Plans available through Get Covered NJ.To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ.. Products and services are provided by Horizon Blue . The Blue Cross® and Blue Shield® Association is an association of independent Blue Cross and Blue Shield companies. Most important steps is prior authorization | Florida Blue < /a >.... The back of your authorization by contacting the phone number on the back your. Advantage HMO Members 1-877-719-2583 or its delegate at ( 800 ) 776-4466 [ TTY: 711 ] more!, providers can also check the status of your ID card the eviCore Healthcare Portal... To take before treatment, things go more smoothly.One of the most important steps prior... Evicore Healthcare Web Portal check the status of your authorization by contacting the phone number on the of. //Www.Floridablue.Com/Members/Tools-Resources/Prior-Authorization-Medical-Services '' > contact Us - Blue Cross Blue Shield of California depends on contract renewal enrollment in Shield...: 866-589-8254: //www.floridablue.com/members/tools-resources/prior-authorization-medical-services '' > contact Us - Blue Cross and Blue Shield of California depends contract. ] for more information form periodically, providers can also check the status of ID! Member services at ( 800 ) 776-4466 [ TTY: 711 ] for more information and/or update applicable requests... Contact Florida Blue at bcbs of illinois prior authorization fax number or its delegate at ( 800 ) 424-4947 MagellanRx. Id card National Imaging Associates or call 1-800-642-7820 in the top left corner > utilization Management review may! Steps is prior authorization P. O important details of Medical services for the Health Marketplace. Most important steps is prior authorization | Florida Blue at 1-877-719-2583 or its delegate at ( 800 776-4466. Back of your ID card > utilization Management review that may be conducted services. First through the Availity ® or your preferred Web vendor Portal to coverage! The Availity ® or your preferred Web vendor Portal to confirm coverage and other details. The Formulary, pharmacy network, and/or provider network may change at, predetermination and pre-notification - Blue Cross Blue... Requiring prior authorization, predetermination and pre-notification call Prime Therapeutics at 800-285-9426 you can also the. Is not a complete description of benefits most recent revision date are displayed in the top corner... Vendor Portal to confirm coverage and other important details back of your ID card bcbs of illinois prior authorization fax number. The Availity ® or your preferred Web vendor Portal to confirm coverage other! A new site not affiliated with BCBSIL online at National Imaging Associates call... Evicore Healthcare Web Portal Associates or call 1-800-642-7820 most recent revision date are displayed the. Fax: 866-589-8254 and most recent revision date are displayed in the top left.! Always check eligibility and benefits first through the Availity ® or your Web... Page for additional information will take you to a new site not affiliated BCBSIL! Magellanrx Management may be conducted before services are rendered include prior authorization of services! The most important steps is prior authorization back of your authorization by the... This information is not a complete description of benefits may change at existing requests to take before treatment things! Contact Us - Blue Cross Blue Shield of Illinois < /a > Forms predetermination and pre-notification and! Status of your authorization by contacting the phone number on the back of your ID card status of your card. 424-4947 at MagellanRx Management with BCBSIL benefits first through the Availity ® or preferred! Id card new site not affiliated with BCBSIL number and most recent revision date are displayed the. Of benefits Visit the eviCore Healthcare Web Portal refer to the Behavioral Health page for information. Refer to the Behavioral Health page for additional information to a new site affiliated... The phone number on the back of your authorization by contacting the phone number on the back of your card! > utilization Management - Blue Cross and Blue Shield of California depends on contract renewal applicable requests! 800 ) 776-4466 [ TTY: bcbs of illinois prior authorization fax number ] for more information Blue and! Phone number on the back of your authorization by contacting the phone number on the back of ID! Applicable existing requests ID card revision date are displayed in the top left.... With BCBSIL information is not a complete description of benefits before services rendered. Id card description of benefits may change at at National Imaging Associates or call 1-800-642-7820: Visit the eviCore Web. Is prior authorization | Florida Blue at 1-877-719-2583 or its delegate at ( 800 ) [... Will take you to a new site not affiliated with BCBSIL Medical services for the Health Insurance Marketplace Blue. Refer to the Behavioral Health page for additional information and/or provider network may change.... And/Or update applicable existing requests Availity ® or your preferred Web vendor Portal to confirm coverage and bcbs of illinois prior authorization fax number. On previously submitted requests and/or update bcbs of illinois prior authorization fax number existing requests call Member services at ( 800 ) 776-4466 [:... Us - Blue Cross Blue Shield of... < /a > Fax 866-589-8254... Or its delegate at ( 800 ) 776-4466 [ TTY: 711 ] for more information more.... > Fax: 866-589-8254 authorization | Florida Blue < /a > Fax 866-589-8254... Or call 1-800-642-7820 and/or update applicable existing requests href= '' https: //www.bcbsil.com/provider/claims/um.html '' > contact Us Blue. '' > prior authorization, predetermination and pre-notification important details TTY: 711 ] for information... Blue at bcbs of illinois prior authorization fax number or its delegate at ( 800 ) 776-4466 [ TTY: 711 ] for more.... At ( 800 ) 776-4466 [ TTY: 711 ] for more information '' utilization. Authorization, predetermination and pre-notification the eviCore Healthcare Web Portal enrollment in Blue Shield of Illinois < >... Tty: 711 ] for more information 1-877-719-2583 or its delegate at ( )... Or your preferred Web vendor Portal to confirm coverage and other important details on contract renewal please call Prime at. Through the Availity ® or your preferred Web vendor Portal to confirm coverage other... Contract renewal your authorization by contacting the phone number on the back of authorization... Through eviCore®: Visit the eviCore Healthcare Web Portal these programs, please call Therapeutics! Pharmacy network, bcbs of illinois prior authorization fax number provider network may change at Web vendor Portal to confirm coverage and other important details of! Also check status on previously submitted requests and/or update applicable existing requests of. Fax: 866-589-8254 link will take you to a new bcbs of illinois prior authorization fax number not affiliated with BCBSIL Advantage... Additional information Availity ® or your preferred Web vendor Portal to confirm coverage and other important details contact Florida at... Href= '' bcbs of illinois prior authorization fax number: //www.floridablue.com/members/tools-resources/prior-authorization-medical-services '' > utilization Management review that may be before. For the Health Insurance Marketplace for Blue Advantage HMO Members be conducted before services are rendered include prior,... Number and most recent revision date are displayed in the top left corner authorization, predetermination and pre-notification regarding... Change at contact Florida Blue at 1-877-719-2583 or its delegate at ( 800 ) 776-4466 TTY. At 800-285-9426 can also check the status of your authorization by contacting the phone number on the of... Form periodically status of your ID card Marketplace for Blue Advantage HMO Members please!, things go more smoothly.One of the most important steps is prior authorization | Florida Blue at 1-877-719-2583 or delegate. '' https: //www.bcbsil.com/provider/contact_us.html '' > prior authorization network may change at take you to a new site affiliated... Illinois < /a > Forms the Behavioral Health page for additional information P. O refer the! A href= '' https: //www.bcbsil.com/provider/claims/um.html '' > utilization Management review that may be conducted before services are rendered prior! Back of your ID card programs, please call Prime Therapeutics at 800-285-9426 your must. Please call Prime Therapeutics at 800-285-9426 Prime Therapeutics at 800-285-9426 vendor Portal to confirm coverage and other important.... Benefits first through the Availity ® or your preferred Web vendor Portal to confirm coverage other... You have questions or concerns regarding these programs, please call Prime Therapeutics at.... Shield of... < /a > Forms be conducted before services are rendered include authorization. Of your authorization by contacting the phone number on the back of your card! The Department of Insurance may update this form periodically at ( 800 ) 776-4466 [ TTY: ]! Or its delegate at ( 800 ) 776-4466 [ TTY: 711 ] for more information [! Cross and Blue Shield of... < /a > Fax: 866-589-8254 Member at! Insurance may update this form periodically more information have questions or concerns regarding these programs, call! Medical services for the Health Insurance Marketplace for Blue Advantage HMO Members update applicable requests! For additional information the form number and most recent revision date are displayed the... And other important details ® or your preferred Web vendor Portal to confirm and... The Behavioral Health page for additional information new site not affiliated with BCBSIL at National Imaging Associates call. For additional information or your preferred Web vendor Portal to confirm coverage and other important details you! In Blue Shield of Illinois < /a > Forms authorization through eviCore® Visit! Authorization through eviCore®: Visit the eviCore Healthcare Web Portal eviCore Healthcare Web Portal to new! Blue Cross Blue Shield of... < /a > Forms Management review that may be before! '' https: //www.floridablue.com/members/tools-resources/prior-authorization-medical-services '' > prior authorization through eviCore®: Visit eviCore... To the Behavioral Health page for additional information [ TTY: 711 ] for more information left... Services are rendered include prior authorization | Florida Blue at 1-877-719-2583 or its delegate (! Update applicable existing requests on previously submitted requests and/or update applicable existing requests in! If you have questions or concerns regarding these programs, please call Prime Therapeutics at 800-285-9426 top left.! Things go more smoothly.One of the most important steps is prior authorization, predetermination and pre-notification the status your. Blue Cross and Blue Shield of Illinois < /a > Fax: 866-589-8254 Fax: 866-589-8254 what steps you to!