Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. The digital lookup tool is intended for reference purposes only. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. During weekend hours, UM reviewers and medical directors continue to review requests and make decisions. The Customer Service representative will provide you a reference number, which can be used to track the dispute. 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. While not included in the digital lookup tool, some services always require prior authorization, such as inpatient facility admissions. These requests must be decided within 48 hours for BCCHP members, and 72 hours for MMAI members. Topics include everything from improving your well-being to explaining health coverage. February 1, 2021 Blue Cross and Blue Shield of Illinois (BCBSIL) would like to outline important updates, tips and reminders on prior authorization processes for independently contracted providers treating our Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. Blue Cross and Blue Shield of Illinois (BCBSIL) would like to outline some important updates, tips and reminders on prior authorization processes for independently contracted providers treating our Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. Stay informed about BCBSIL programs, products, initiatives, and more. Provider | Blue Cross and Blue Shield of Illinois - BCBSIL Your feedback is vital to improving the care and services these members receive. Your PCP will handle the prior authorization process. These tools used by PCPs (or specialists) include medical codes. Convey Health Solutions, Inc. is an independent company that provides administrative services for over-the-counter supplemental benefits for Blue Cross and Blue Shield of Illinois. PDF Medicaid Prior Authorization Requirements Summary, Effective Jan. 1 To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM The Centers for Medicare & Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement MMAI. How to File a Claims Dispute using Enterprise Appeals Application (EAA) Tracking ID 1. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) You'll see details that may help lower health care costs. Log in to your account to get the most accurate, personalized search results based on your plan. How to request prior authorization: Prior authorization requests may be made by phone (call 877-860-2837 for BCCHP members, call 877-723-7702 for MMAI members) or by fax to 312-233-4060 (same fax number for BCCHP and MMAI). All Rights Reserved. Information on Service Authorization Disputes can be found on the Provider Service Authorization Dispute Resolution Request Form. According to AllTrails.com, the longest historic site trail in Wetter is RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen. From Essen-Kupferdreh back with the S-Bahn to the main station and from there without changing with the RE 16 back to Siegerland. Refer to our Medicaid prior authorization summary for more details. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. This list includes generic and brand drugs and medical supplies. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. Search for doctors, dentists, hospitals and other health care providers. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. One option is Adobe Reader which has a built-in reader. To support the decision process, BCBSIL gives providers the opportunity to discuss UM determinations with a peer physician. The next highest ascent for historic site trails is. MMAI Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. BCBSIL adheres to the standards for addressing all urgent concurrent requests, meeting or exceeding National Committee for Quality Assurance (NCQA) standards. Also, some services need approval before treatment or services are received. endstream endobj 374 0 obj <. hb``0b`0 36 fah@t#(f`XU1U B)xPB2@+4s\ X:EolHd]1ofxF/120i7@ZN 4`SBa@3P]8D5/@ F& endstream endobj 13 0 obj <>]/Pages 10 0 R/Perms/Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/Type/Catalog/ViewerPreferences<>>> endobj 14 0 obj <. If you do not use the $30, it does not roll over into the next three months. For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. You are leaving this website/app ("site"). Home Search your plan's drug list, find a pharmacy, and more. For other services/members, BCBSIL has contracted with eviCore healthcare (eviCore) for utilization management and related services. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. What: Q2 2023 MMAI and BCCHP Community Stakeholder Committee Meeting R{O *L%U}r?:B22Rj=]p ($c j `-g [W}]blE&rT}TmPi]`8*I/,%,((56eA lLlkFy_&df4]`)`m9lrSQHp*:Y0T"NEAu:",@vR8za7nn7I,Iz-rSroq@T#}MW *7I :=C;hEQQq_1d"A B M$ }u$z Life changes happen at any time. Most PDF readers are a free download. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice. @SssUJ- =`~4*>_faS A$wa8|9NN4 d>!XHDhf\~%r'7m|oHF~D#R X(b(uQu (pd)8MA/> ?&ME.@.$O4>!Mwiw%c:IlAc:4U&SUDaE:?{Or-RaX%,(( Request a new replacement member ID card, or download a temporary copy. You also have the right to ask for a coverage decision. Blue Cross Community MMAI has strict rules about how decisions are made about your care. Medical Policies are based on scientific and medical research. This step helps you confirm membership, coverage and other details, including prior authorization requirements and utilization management vendors. x=r8?Qi xJI&JfIl3D:#SfAw $nb"n q~+|Vz?p~Q{vrle{{_F^gEx6,>/?e=kOws/nTgO~S>)ga0)D>Mx,lN}=v,QPD>j" <> Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. The code lists are posted as PDFs so you can scroll through pages manually or enter to search, highlight and advance to all instances of a particular word or number. A provider may initiate a peer-to-peer discussion by calling 800-981-2795. This is the third stage of the varied WestfalenWanderWeg, which leads 216 km from Hattingen through the southern Ruhr area, the Paderborn region and the foothills of the Sauerland to Altenbeken in the Teutoburg Forest / Eggegebirge nature park. Whats new on the web? Clear and timely submission of prior authorization requests and clinical documentation is very important to process requests within the required timeframes. PDF Medicare-Medicaid Alignment Initiative (MMAI) Demonstration Frequently Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. For BCCHP and MMAI: Peer-to-peer discussions are allowed for requests where clinical information was submitted with the original request. 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. 373 0 obj <> endobj Sign up! Talk with your doctor about your medication. Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. You may be familiar with some of the Medicaid prior authorization resources on our Provider website. See below for details, including the Zoom registration link. eviCore healthcare (eviCore) is an independent company that has contracted with Blue Cross and Blue Shield of Illinois to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. The peer-to-peer discussion process is as follows: *Effective May 1, 2021, the only change is that providers can no longer submit clinicals for BCCHP members IN ADDITION TO doing a peer-to-peer call after the adverse determination. ALLTRAILS and the AllTrails Mountain Design are registered trademarks of AllTrails, LLC in the United States as well as certain other jurisdictions. This new site may be offered by a vendor or an independent third party. The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. Who is responsible for getting the prior authorization? It also includes the drugs covered by Medicare Part D. As a member, you have no copay for covered items on the Drug List. We're hosting quarterly Community Stakeholder Committee meetings to find ways to better serve our Blue Cross Community MMAI (Medicare-Medicaid Plan) SM and Blue Cross Community Health Plans SM (BCCHP) members. How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SMMake Decisions for Prior Authorizations? Your doctor will need to request approval before these drugs can be prescribed. MCG (formerly Milliman Care Guidelines) is a trademark of MCG Health, LLC (part of the Hearst Health network), an independent third party vendor. Returning Shopper? Get the most from your BCBSIL pharmacy benefits. endstream endobj startxref Blue Cross Community Health Plans and Blue Cross Community MMAI plans are provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. PDF Post-Acute Care Utilization Management Program for Blue Cross and Blue How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Make Decisions for Prior Authorizations? Members should contact the customer service number on their member ID card for more specific coverage information. Medicaid Prior Authorization Request Form, Provider Service Authorization Dispute Resolution Request Form. Medical policies are also used to guide care decisions. One option is Adobe Reader which has a built-in reader. Its a great chance to work with faith leaders, advocacy groups and other community-based organizations that support our members health and well-being. Updated February 2021 1 Medicaid Prior Authorization Requirements Summary, Effective Jan. 1, 2021 (Updated February 2021) This information applies to Blue Cross Community MMAI (Medicare-Medicaid)SM and Blue Cross Community Health PlansSM (BCCHPSM) members. They use what is called clinical criteria to make sure you get the health care you need. Simply enter a 5-digit code, service description or drug name in the search field. Availity provides administrative services to BCBSIL.