Blue Cross Illinois Updates Prior Authorization Protocols

Blue Cross and Blue Shield of Illinois has announced revised prior authorization requirements for members enrolled in its Medicare Advantage, Community Health Plans, and Medicare-Medicaid Plan programs. These changes stem from updates in utilization management practices and recent code modifications from reputable sources like the American Medical Association and the Centers for Medicaid & Medicare Services.

Under the new guidelines, certain services may require prior authorization, and some members will have their prior authorizations managed by eviCore Healthcare. Providers are urged to verify eligibility and benefits through Availity Essentials before providing services to ensure compliance with the updated requirements.

It is essential for providers to obtain prior authorization where necessary, as failure to do so could result in denied payment for services rendered. The announcement emphasizes the importance of understanding member coverage terms to avoid potential claim processing issues and stresses that verifying benefits does not guarantee payment. Members should reference the information on their ID cards for contact details if they have queries.