If you have any questions, call the number on the members ID card. The next highest ascent for historic site trails is. For some drugs, the plan limits the amount that will be covered. Your doctor will need to request approval before these drugs can be prescribed. Most PDF readers are a free download. Stay informed about BCBSIL programs, products, initiatives, and more. Also, some services need approval before treatment or services are received. Returning Shopper? As you transition to Medicare, we hope you'll Stay with Blue and get Medicare coverage from a company you trust. 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. At Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, we take great pride in ensuring that you receive the care you need. 101 S. River Street However, you can order these items once every three months. One option is Adobe Reader which has a built-in screen reader. 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. How do I know if I need a prior authorization? The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. 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. Click here to see prior authorization tools, clinical review criteria and MMAI Medical Policies used by your doctor to make a decision. Home Renew Illinois Individual, Family & Medicaid Health Insurance, Blue Cross Community MMAI (Medicare-Medicaid Plan), Illinois Health Plan Tiered Prescription Drug Lists, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. It will open in a new window. Whens the meeting for the next quarter? This new site may be offered by a vendor or an independent third party. 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" Doctors are not paid to deny care. Copyright 2021 Health Care Service Corporation. 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. hbbd```b``nF`+d'lO0{d&WEV"8EVU9`"DaDa@6`4r lf|pwOIF@W; v#30^0 !X endstream endobj startxref 0 %%EOF 107 0 obj <>stream 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. endstream endobj startxref There are no rewards to deny or promote care. endstream endobj 374 0 obj <. Want to be part of our amazing team? Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. You are leaving this website/app ("site"). BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. Our doctors and staff make decisions about your care based on need and benefits. All rights reserved. What is the longest historic site trail in Wetter? For BCCHP and MMAI: Peer-to-peer discussions are allowed for requests where clinical information was submitted with the original request. You may be familiar with some of the Medicaid prior authorization resources on our Provider website. %PDF-1.7 YDLmW~/Pi_7wRwN]_RwMFrg~ w BJA9V)F:C5F7\(]U{8-KBC T.~mj mBlw~ C5?eja3\p0FooS"_iNQq9;H`76 97hQsD0O8IL*]"w}mP2H#^mHqMD[kn>iE7T" + {pxk4(uN7Lmgw5oCOa1 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. To view this file, you may need to install a PDF reader program. Medical Policies are based on scientific and medical research. References to other third party sources or organizations are not a representation, warranty or endorsement of such organizations. Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. 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 Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. For more information, refer to the 2021 Medicaid Prior Authorization Requirements Summary and 2021 Medicaid Prior Authorization Code List available in the Medicaid section on the Support Materials (Government Programs) page. Prior Authorization Support Materials (Government Programs). 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. In addition, some sites may require you to agree to their terms of use and privacy policy. To help ensure turnaround times are met and decisions are provided to requesting providers as quickly as possible, BCCHP and MMAI utilization management (UM) reviewers and medical directors are available seven days a week, excluding BCBSIL identified holidays. 1 0 obj Refer to important information for our linking policy. One Wetter: With an ascent of 703 m, WestfalenWanderWeg Etappe 3: Wetter - Schwerte has the most elevation gain of all of the historic site trails in the area. The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. The digital lookup tool is intended for reference purposes only. Procedure code lists are provided for reference purposes. These include prior authorization code lists with effective dates and related information for Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Your feedback is vital to improving the care and services these members receive. Topics include everything from improving your well-being to explaining health coverage. 415 0 obj <>stream <>/Metadata 528 0 R/ViewerPreferences 529 0 R>> Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Explore Out-of-Network Coverage for more information about your network. The health of your eyes and teeth can affect your overall health. 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$z All Rights Reserved. Qf#yQ>u(KpRE{UIQp[)5T:p:jBFp*WWhwIA36YwNG)!G/!Yr6v7e|12 rUp3?R1H-6Kre vh) yj?O&y]\x,$aU7Mm'a 5a1owahiT@IC+ If no clinical information was submitted with a request, a peer-to-peer discussion is not permitted. FIND YOUR WAY OUTSIDE is a trademark of AllTrails, LLC. April 24, 2023. External link You are leaving this website/app (site). 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. `9wL The plan will pay up to $30 (plus $5 for shipping) for each order. BCBSIL adheres to the standards for addressing all urgent concurrent requests, meeting or exceeding National Committee for Quality Assurance (NCQA) standards. Request a new replacement member ID card, or download a temporary copy. When faxing prior authorization requests, you must use the Medicaid Prior Authorization Request Form. The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois (BCBSIL) government programs members enrolled in any of the following plans: 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. To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. The peer-to-peer discussion is not required, nor does it affect the providers right to an appeal on behalf of a member. 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. To view this file, you may need to install a PDF reader program. Medicaid Prior Authorization Request Form, Provider Service Authorization Dispute Resolution Request Form. Register Now. %PDF-1.6 % Which historic site trail has the most elevation gain in Wetter? Failing to provide clinical information or timely notification of prior authorization requests may affect the outcome of a Service Authorization Dispute. Its a great chance to work with faith leaders, advocacy groups and other community-based organizations that support our members health and well-being. 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. This new site may be offered by a vendor or an independent third party. The ASAM Criteria, 2021 American Society of Addiction Medicine. 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. For some services/members, prior authorization may be required through BCBSIL. 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 <. To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section. related information. The site may also contain non-Medicare related information. All Rights Reserved. According to AllTrails.com, the longest historic site trail in Wetter is. endobj Related Resources Search articles and watch videos; ask questions and get answers. 396 0 obj <>/Filter/FlateDecode/ID[<0A7FBF13C253BF478050EB5B54DA8A47><3D37E1700F053247902B206B607ACED5>]/Index[373 43]/Info 372 0 R/Length 112/Prev 171011/Root 374 0 R/Size 416/Type/XRef/W[1 3 1]>>stream 2 0 obj (Accessible to providers through the BCBSIL-branded Payer Spaces section in, 2022 MA PPO and MA HMO Non-Delegated Prior Authorization Requirements Summary, 2022 MA PPO and MA HMO Non-Delegated Prior Authorization Code List, 2022 Medicaid Prior Authorization Requirements Summary, 2022 Medicaid Prior Authorization Code List, American Society of Addiction Medicine (ASAM), Illinois Department of Human Services/Division of Mental Health, Illinois Department of Health and Family Services Medicaid Provider Handbooks, Utilization Management Process Overview (Gov Programs), Blue Cross Medicare Advantage HMO Non-Delegated Model, Blue Cross Community MMAI (Medicare-Medicaid Plan). In addition, some sites may require you to agree to their terms of use and privacy policy. You can find out if your drug has any added conditions or limits by looking at the Drug List. Availity provides administrative services to BCBSIL. Legal and Privacy Certain drugs on the list need prior authorization. hbbd```b``6O L %,"&*u`0;L:`5 ; This is called prior authorization, preauthorization, pre-certification or prior approval. How to File a Claims Dispute using Enterprise Appeals Application (EAA) Tracking ID 1. This list includes generic and brand drugs and medical supplies. From the train station through the underpass, it goes straight across the street to the Ruhr cycle path. Frequently asked questions about historic site trails in Wetter. Use the links below to view BCBSIL and vendor guidelines that may apply. 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. 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 table below contains some of the services covered under your plan. This trail is estimated to be 42.6 km long. }&ji[@_{dsTchsqD7bL+x3AXG>z>(y{+/en6=V/e{.t&>jFj750hS) !yppH7edMUFA{u38_tZ'oKAlr, @qiD This approval is called "prior authorization." To return to our website, simply close the new window. Explore the most popular historic site trails near Wetter with hand-curated trail maps and driving directions as well as detailed reviews and photos from hikers, campers and nature lovers like you. 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. endobj During weekend hours, UM reviewers and medical directors continue to review requests and make decisions. 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 BCBSIL Provider Manuals are comprehensive guides for Blue Cross Community Health Plans SM, Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, Blue Cross Medicare Advantage (HMO) SM, Blue Cross Medicare Advantage (PPO) SM, Blue Choice PPO SM, HMO, PPO and Blue High Performance Network (Blue HPN ) EPO professional and facility providers. You'll see details that may help lower health care costs. Non-Discrimination Notice. Your doctor should know which services need approval and can help with the details. Highlights: Our guest speaker is Sara Gray, Executive Director of National Alliance on Mental Illness, Kane-south, DeKalb and Kendall Counties. Out-of-Network Coverage. Stage 3 of the long-distance hiking trail WestfalenWanderWeg, North Rhine-Westphalia. Medical Benefits Blue Cross Community MMAI (Medicare-Medicaid Plan) SM covers many of your health care needs. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. 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. Davis Vision is an independent company that has contracted with BCBSIL to provide vision benefits administration for government programs members with coverage through BCBSIL. Providers are allowed the opportunity to schedule one peer-to-peer discussion per adverse determination. You also have the right to ask for a coverage decision. To see if you are eligible, Contact:Blue Cross and Blue Shield of Illinois' OTC vendor,Convey Health Solutions, at: 1-855-891-5274. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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. Out of area dialysis services. GDChv0O{Q~ $W0!&~(c~;=1^!GD=q2z5OR%AG.)H&lz'9|^f!(@.ib We'd like to invite you to join us for our next committee meeting on May 18, 2023. The next highest ascent for historic site trails is Von Wetter zum Nacken with 664 m of elevation gain. As of this date, providers may submit a new packet for clinical re-review OR do a peer-to-peer discussion. Provider Finder. See Chapter 4 of theMember Handbookon the Forms & Documents page for more details. Your Summary of Benefits has information about which services require prior authorization. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment. Search for doctors, dentists, hospitals and other health care providers. To support the decision process, BCBSIL gives providers the opportunity to discuss UM determinations with a peer physician. How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Make Decisions for Prior Authorizations? Where: Hybrid, Join us in person: Most PDF readers are a free download. One option is Adobe Reader which has a built-in screen reader. endobj Were 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 PlansSM(BCCHP) members. These requests must be decided within 48 hours for BCCHP members, and 72 hours for MMAI members. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. 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. This step will help you confirm prior authorization requirements and utilization management vendor information, if applicable. Choose the best payment option for your Blue Cross and Blue Shield of Illinois (BCBSIL) monthly bill. Log in to your account to get the most accurate, personalized search results based on your plan. Whats new on the web? In addition, some sites may require you to agree to their terms of use and privacy policy. The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Your PCP will handle the prior authorization process. In most cases, you must receive your care from a Blue Cross Community MMAI (Medicare-Medicaid Plan) SM in-network plan provider. Additionally, the Provider Service Authorization Dispute process is available when an adverse service authorization has been rendered and the UM process has been followed. In addition, some sites may require you to agree to their terms of use and privacy policy. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. External link You are leaving this website/app (site). For some services/members, prior authorization may be required through BCBSIL. Limitations of Covered Benefits by Member Contract 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. Medicaid Prior Authorization Request Form Please fax completed form to 312-233-4060 This information applies to Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. You pay nothing ($0) when you go to a doctor or health care provider in the plan's network. Create an account. All Rights Reserved. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. ALLTRAILS and the AllTrails Mountain Design are registered trademarks of AllTrails, LLC in the United States as well as certain other jurisdictions. In addition, some sites may require you to agree to their terms of use and privacy policy. Whats on the agenda? Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. This step helps you confirm membership, coverage and other details, including prior authorization requirements and utilization management vendors. Well also include reminders in the Blue Review. When: Thursday, May 18, 2023, from 1 to 2:30 p.m. CST #5 - RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, #6 - WestfalenWanderWeg Etappe 3: Wetter - Schwerte. Your plan does not encourage doctors to give less care than you need. option is Adobe Reader which has a built-in reader. The peer-to-peer discussion is available as a courtesy to providers. 2. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. 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. It also includes the drugs covered by Medicare Part D. As a member, you have no copay for covered items on the Drug List. Check out our Corporate Social Responsibility Reportto learn the ways we're serving our community. This link will take you to a new site not affiliated with BCBSIL. Members should contact the customer service number on their member ID card for more specific coverage information. 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. We also feature guest speakers and allow time for a general Q&A. The site may also contain non-Medicare related information. 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. From Essen-Kupferdreh back with the S-Bahn to the main station and from there without changing with the RE 16 back to Siegerland. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). hb```) ea&pd:Se Once additional meetings are confirmed, well alert you via the News and Updates. Most PDF readers are a free download. New User? Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Join us as we build the next generation of health insurance. 3 0 obj If a request does not meet medical necessity criteria for approval, the request will be assigned to a BCBSIL medical director for determination. Step-by-Step Guide for Provider Finder. Who is responsible for getting the prior authorization? 12 0 obj <> endobj 64 0 obj <>/Filter/FlateDecode/ID[<377B542E37144E99AA8D3C27588EFAA9><9D42E3C64D6B4195AB6A428BC62E2046>]/Index[12 96]/Info 11 0 R/Length 151/Prev 468246/Root 13 0 R/Size 108/Type/XRef/W[1 3 1]>>stream

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