Checking eligibility and benefits through Availity Essential or your preferred web vendor is always the best place to start, before you provide care and services to any of our members. This step helps you confirm membership, coverage and other details, including prior authorization requirements and utilization management vendors. But we know it’s nice to have other ways to view prior authorization information, too.
You may be familiar with some of the Medicaid prior authorization resources on our Provider website. 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. 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.
What’s new on the web?
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.
To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section.
While not included in the digital lookup tool, some services always require prior authorization, such as inpatient facility admissions. Refer to our Medicaid prior authorization summary for more details.
The digital lookup tool is intended for reference purposes only. Information provided is not exhaustive and is subject to change. Always check eligibility and benefits through Availity or your preferred web vendor before rendering services. This step will help you confirm prior authorization requirements and utilization management vendor information, if applicable.
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. 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 member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider. If you have any questions, call the number on the member's BCBSIL 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. 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. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.
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