FIND YOUR WAY OUTSIDE is a trademark of AllTrails, LLC. We know you like to plan ahead. Once additional meetings are confirmed, well alert you via the News and Updates. Contact Us | Blue Cross and Blue Shield of Illinois Contact Us 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.
For other services/members, BCBSIL has contracted witheviCore healthcare (eviCore)for utilization management and related services. Returning Shopper? #5 - RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, #6 - WestfalenWanderWeg Etappe 3: Wetter - Schwerte. File is in portable document format (PDF). Who is responsible for getting the prior authorization? Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. In most cases, you must receive your care from a Blue Cross Community MMAI (Medicare-Medicaid Plan) SM in-network plan provider. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice. It is the responsibility of the requesting provider to submit clinical documentation to substantiate a request for services at the time of the service authorization request. Refer to important information for our linking policy. Medicaid Prior Authorization Request Form, Provider Service Authorization Dispute Resolution Request Form. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM Always check eligibility and benefits first through Availity or your preferred web vendor portal to confirm coverage and other important details, including prior authorization requirements and vendors, if applicable. External link You are leaving this website/app (site). Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice, Have a prescription from your doctor for them, Fill the prescription at a network pharmacy. Legal and Privacy
If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. 373 0 obj
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Our doctors and staff make decisions about your care based on need and benefits. Members should contact the vendor(s) directly with questions about the products or services offered by third parties. endobj
The site may also contain non-Medicare
Some services need approval from your health plan before you get treated. What is the most popular and difficult historic site trail in Wetter? 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. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Davis Vision is an independent company that has contracted with BCBSIL to provide vision benefits administration for government programs members with coverage through BCBSIL. Your doctors will use other tools to check prior authorization needs. Register Now. We'd like to invite you to join us for our next committee meeting on May 18, 2023. Your doctors will use other tools to check prior authorization needs. %
Information provided is not exhaustive and is subject to change. This link will take you to a new site not affiliated with BCBSIL. Wed like to invite you to join us for our next committee meeting on May 18, 2023. 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. Medical Benefits Blue Cross Community MMAI (Medicare-Medicaid Plan) SM covers many of your health care needs. BCBSIL adheres to the standards for addressing all urgent concurrent requests, meeting or exceeding National Committee for Quality Assurance (NCQA) standards. <>/Metadata 528 0 R/ViewerPreferences 529 0 R>>
Your doctor will need to request approval before these drugs can be prescribed. This approval is called "prior authorization." This new site may be offered by a vendor or an independent third party. k+:6@1)^]WNQj sGG&
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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. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Our doctors and staff make decisions about your care based on need and benefits. Use the links below to view BCBSIL and vendor guidelines that may apply. Blue Cross Community MMAI has strict rules about how decisions are made about your care. New User? The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. BCBSIL makes no endorsement, representations or warranties regarding third-party vendors. From the train station through the underpass, it goes straight across the street to the Ruhr cycle path. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) If we do not receive adequate clinical documentation, BCBSIL will reach out to your facility UM department and provide a date and time in which clinical documentation is required to be received. eviCore healthcare (eviCore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. Most PDF readers are a free download. 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. 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. Log In to the Shopping Cart, Need to Make a Payment? Explore Out-of-Network Coverage for more information about your network. We are also the largest provider of health benefits in Illinois, serving more than 8.9 million members in all 102 counties across the state. URGENT (If checked, please provide anticipated date of service below) How to File a Claims Dispute using Enterprise Appeals Application (EAA) Tracking ID 1. 3 0 obj
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Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Pharmacy Benefit Prior Authorization Requirements Prime Therapeutics, our pharmacy benefit manager, conducts all reviews of prior authorization requests from physicians for BCBSIL members with prescription drug coverage. 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. How do I know if I need a prior authorization? The site may also contain non-Medicare related information. Your doctor will choose which drug is best for you. 4 0 obj
April 24, 2023. Related Resources Stage 3 of the long-distance hiking trail WestfalenWanderWeg, North Rhine-Westphalia. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Sign up for theLifeTimes newsletterto get health and benefits articles delivered to your inbox every month. New User? This is called prior authorization, preauthorization, pre-certification or prior approval. Certain drugs on the list need prior authorization. Some benefit plans administered by BCBSIL, such as some self-funded employer plans or governmental plans, may not utilize BCBSIL Medical Policies. File is in portable document format (PDF). The ASAM Criteria, 2021 American Society of Addiction Medicine. Search articles and watch videos; ask questions and get answers. Prior authorization requests for administrative days (ADs) may not be submitted online at this time. {0c8Lp~#g.wS,#.z
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sDH- rst !-`*M68G#gYmw/|O|)- Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. External link You are leaving this website/app (site). Personal health-related items (such as a toothbrush and toothpaste) are not included on this list. You are leaving this website/app (site). Doctors are not paid to deny care. But we know its nice to have other ways to view prior authorization information, too. Prior Authorization Doctors and Hospitals When choosing a doctor, make sure the doctor is part of the Blue Cross Community MMAI (Medicare-Medicaid Plan) SM network. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes: Medical benefits such as coverage for preventive care services, emergency and urgent care coverage, diagnostic tests and more Behavioral Health benefits Prescription coverage Transportation Services to help you get to and from your appointments Dental care, eye care, and more }&ji[@_{dsTchsqD7bL+x3AXG>z>(y{+/en6=V/e{.t&>jFj750hS)
!yppH7edMUFA{u38_tZ'oKAlr, @qiD To see if you are eligible, Contact:Blue Cross and Blue Shield of Illinois' OTC vendor,Convey Health Solutions, at: 1-855-891-5274. Most PDF readers are a free download. Want to be part of our amazing team? 415 0 obj
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For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. One option is Adobe Reader which has a built-in screen reader. Check out our Corporate Social Responsibility Reportto learn the ways we're serving our community. All Rights Reserved. Well also include reminders in the Blue Review. Also, some services need approval before treatment or services are received. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Your PCP will handle the prior authorization process. Create an account. As you transition to Medicare, we hope you'll Stay with Blue and get Medicare coverage from a company you trust. Where: Hybrid, Join us in person: MCG (formerly Milliman Care Guidelines) is a trademark of MCG Health, LLC (part of the Hearst Health network), an independent third party vendor. The digital lookup tool is intended for reference purposes only. One option is Adobe Reader which has a built-in reader. Customer Service: File the dispute by calling Customer Service at 1-877-860-2837. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM Always check eligibility and benefits first through Availity or your preferred web vendor portal to confirm coverage and other important details, including prior authorization requirements and vendors, if applicable. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. endstream
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The peer-to-peer discussion is not required, nor does it affect the providers right to an appeal on behalf of a member. Registration is required. The most popular and difficult historic site trail in Wetter is, RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, WestfalenWanderWeg Etappe 3: Wetter - Schwerte. These include prior authorization code lists with effective dates and related information for Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. 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. Providers are instructed to exercise their own clinical judgment based on each individual patients health care needs.
If you have any questions, call the number on the member's BCBSIL ID card. Information on Service Authorization Disputes can be found on the Provider Service Authorization Dispute Resolution Request Form. ALLTRAILS and the AllTrails Mountain Design are registered trademarks of AllTrails, LLC in the United States as well as certain other jurisdictions. To return to our website, simply close the new window. 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. If no clinical information was submitted with a request, a peer-to-peer discussion is not permitted. All Rights Reserved. %%EOF
In addition, some sites may require you to agree to their terms of use and privacy policy. Additional clinical information will not be reviewed by the utilization management team if the initial determination was an adverse determination due to failure to submit clinical information with the original request. From Essen-Kupferdreh back with the S-Bahn to the main station and from there without changing with the RE 16 back to Siegerland. This new site may be offered by a vendor or an independent third party. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. Whens the meeting for the next quarter? 2 0 obj
This step will help you confirm prior authorization requirements and utilization management vendor information, if applicable. There are no rewards to deny or promote care. The tool returns a list of services that may require prior authorization through BCBSIL or eviCore healthcare (eviCore) for BCCHP and MMAI members. *Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. There are some exceptions when care you receive from an out-of-network provider will be covered. If you have any questions, call the number on the members ID card. One option is Adobe Reader which has a built-in screen reader. For some services/members, prior authorization may be required through BCBSIL. You also can call the MMAI plan's pharmacy help-line. DV. %PDF-1.6
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See below for details, including the Zoom registration link. Please see Drug Information for more information. 396 0 obj
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For some services/members, prior authorization may be required through BCBSIL. The health of your eyes and teeth can affect your overall health. All Rights Reserved. 0
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GDChv0O{Q~ $W0!&~(c~;=1^!GD=q2z5OR%AG.)H&lz'9|^f!(@.ib The code lists are posted as PDFs so you can scroll through pages manually or enter <CTRL F> to search, highlight and advance to all . For BCCHP and MMAI: Peer-to-peer discussions are allowed for requests where clinical information was submitted with the original request. Your plan covers the items in the Drug List as long as you: To see your plan's Drug List, go toForms & Documents. A provider may initiate a peer-to-peer discussion by calling 800-981-2795. Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. Welcome. Recently, we added a digital lookup tool that gives you a different way to view prior authorization requirements that may apply to our BCCHP and MMAI members. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the members policy certificate and/or benefits booklet and or summary plan description. Most PDF readers are a free download. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. hb```) ea&pd:Se Its a great chance to work with faith leaders, advocacy groups and other community-based organizations that support our members health and well-being. Your Summary of Benefits has information about which services require prior authorization. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. If you have a complaint about how we handle any services provided to you, you can file a grievance or an appeal. You are leaving this website/app ("site"). The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. 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. Highlights: Our guest speaker is Sara Gray, Executive Director of National Alliance on Mental Illness, Kane-south, DeKalb and Kendall Counties. See Chapter 4 of theMember Handbookon the Forms & Documents page for more details. Your PCP will handle the prior authorization process. Click here to see prior authorization tools, clinical review criteria and MMAI Medical Policies used by your doctor to make a decision.
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