You also can call the MMAI plan's pharmacy help-line. When faxing prior authorization requests, you must use the Medicaid Prior Authorization Request Form. Which historic site trail has the most elevation gain in Wetter? 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 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. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. We also feature guest speakers and allow time for a general Q&A. The site may also contain non-Medicare related information. New User? 3oDiCBG\{?xyH For more than 85 years, weve provided our members with comprehensive, affordable health plans, making Illinois a healthier place to live, work and play. The site may also contain non-Medicare related information. Sign up! Medicaid | Blue Cross and Blue Shield of Illinois - BCBSIL The most popular and difficult historic site trail in Wetter is, RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, WestfalenWanderWeg Etappe 3: Wetter - Schwerte. @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%,(( GDChv0O{Q~ $W0!&~(c~;=1^!GD=q2z5OR%AG.)H&lz'9|^f!(@.ib Providers are allowed the opportunity to schedule one peer-to-peer discussion per adverse determination. For some services/members, prior authorization may be required through BCBSIL. If an appeal has been filed, the peer-to-peer discussion is no longer available. You are leaving this website/app (site). %%EOF k+:6@1)^]WNQj sGG& hFa`@,%LFPBA7Xmxt$.=e0ne}#IoE 20iF 6Xg8Sf;+-P > Medical Benefits Blue Cross Community MMAI (Medicare-Medicaid Plan) SM covers many of your health care needs. 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. Availity provides administrative services to BCBSIL. Use the links below to view BCBSIL and vendor guidelines that may apply. DV. One Reminder: Hospital 30-day Readmission Review Process for BCCHP and MMAI 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 <. One option is Adobe Reader which has a built-in screen reader. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. What is the most popular and difficult historic site trail in Wetter? Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Failing to provide clinical information or timely notification of prior authorization requests may affect the outcome of a Service Authorization Dispute. Register Now. Sign up for theLifeTimes newsletterto get health and benefits articles delivered to your inbox every month. You can: Pay a bill online or sign up for auto bill pay. Our doctors and staff make decisions about your care based on need and benefits. In addition, some sites may require you to agree to their terms of use and privacy policy. 2023 Best Historic Site Trails in Wetter | AllTrails Create an account. eviCore healthcare manages all Inpatient Post-Acute Care (PAC) preauthorization requests for Blue Cross and Blue Shield of Illinois (BCBSIL) members enrolled in the following programs: Medicare Blue Cross Medicare Advantage (PPO)SM Medicaid Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Out-of-Network Coverage. Out-of-Network Coverage | Blue Cross and Blue Shield of Illinois - BCBSIL 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. For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. But we know its nice to have other ways to view prior authorization information, too. You'll see details that may help lower health care costs. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. All Rights Reserved. Refer to our Medicaid prior authorization summary for more details. Step-by-Step Guide for Provider Finder. The table below contains some of the services covered under your plan. One option is Adobe Reader which has a built-in reader. Santori Library Your PCP will handle the prior authorization process. The site may also contain non-Medicare Whens the meeting for the next quarter? option is Adobe Reader which has a built-in reader. Our trusted community experts can give you the one-on-one help you need to shop for health insurance. This is called prior authorization, preauthorization, pre-certification or prior approval. 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. Most PDF readers are a free download. MMAI Plan Details | Blue Cross and Blue Shield of Illinois - BCBSIL Talk with your doctor about your medication. All Rights Reserved. If you do not use the $30, it does not roll over into the next three months. 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. 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. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 27 0 R 28 0 R 29 0 R 30 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> stream 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. Your plan does not encourage doctors to give less care than you need. Join us as we build the next generation of health insurance. PDF Medicaid Prior Authorization Request Form - BCBSIL Members should contact the vendor(s) directly with questions about the products or services offered by third parties. %PDF-1.6 % Whats on the agenda? Simply enter a 5-digit code, service description or drug name in the search field. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. The peer-to-peer discussion is available as a courtesy to providers. Clinical Review Criteria Utilization management reviews use evidence-based clinical standards of care to help determine whether a benefit may be covered under the members health plan. The peer-to-peer discussion is not required, nor does it affect the providers right to an appeal on behalf of a member. Sara will be discussing Mental Health Awareness Month and cultural competency. Those exceptions are: Emergency care or urgently needed care. Rather than viewing all codes on a running list in a static document, you can use our interactive digital lookup tool to perform a faster, more targeted search. Copyright 2021 Health Care Service Corporation. To view this file, you may need to install a PDF reader program. Certain drugs on the list need prior authorization. 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. 6C("=L,`YF'0 d File is in portable document format (PDF). Our doctors and staff make decisions about your care based only on need and benefits. For BCCHP and MMAI: Peer-to-peer discussions are allowed for requests where clinical information was submitted with the original request. 3 0 obj If you have any questions, call the number on the member's BCBSIL ID card. It also includes the drugs covered by Medicare Part D. As a member, you have no copay for covered items on the Drug List. Updated Provider Dispute Process Overview for Government Programs - BCBSIL 373 0 obj <> endobj Utilization Management | Blue Cross and Blue Shield of Illinois - BCBSIL Aurora, IL 60506. (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). 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. 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. hbbd```b``6O L %,"&*u`0;L:`5 ; Information provided is not exhaustive and is subject to change. Government Programs Prior Authorization Summary and Code ListsRefer to the Summary documents below for an overview of prior authorization requirements, reminders and helpful links. Getting Care Through MMAI | Blue Cross and Blue Shield of Illinois - BCBSIL 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. %PDF-1.6 % You can get one shipment every three months. To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section. 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 . <>/Metadata 528 0 R/ViewerPreferences 529 0 R>> Prior Authorization Support Materials (Government Programs). PDF Post-Acute Care Utilization Management Program for Blue Cross and Blue Your PCP will handle the prior authorization process. Choose the best payment option for your Blue Cross and Blue Shield of Illinois (BCBSIL) monthly bill. From the train station through the underpass, it goes straight across the street to the Ruhr cycle path. Most PDF readers are a free download. The next highest ascent for historic site trails is. 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. You are leaving this website/app ("site"). 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. 2 0 obj During weekend hours, UM reviewers and medical directors continue to review requests and make decisions. Wed like to invite you to join us for our next committee meeting on May 18, 2023. Your feedback is vital to improving the care and services these members receive. Medicaid Prior Authorization Request Form, 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. Personal health-related items (such as a toothbrush and toothpaste) are not included on this list. Check out our Corporate Social Responsibility Reportto learn the ways we're serving our community. Frequently asked questions about historic site trails in Wetter. BCBSIL makes no endorsement, representations or warranties regarding third-party vendors. 4 0 obj 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. PDF Medicaid Prior Authorization Requirements Summary, Effective Jan. 1 The health of your eyes and teeth can affect your overall health. 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). One option is Adobe Reader which has a built-in screen reader. MMAI Medical Benefits | Blue Cross and Blue Shield of Illinois - BCBSIL Your doctor will choose which drug is best for you. 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. x=r8?Qi xJI&JfIl3D:#SfAw $nb"n q~+|Vz?p~Q{vrle{{_F^gEx6,>/?e=kOws/nTgO~S>)ga0)D>Mx,lN}=v,QPD>j" Also, some services need approval before treatment or services are received. MMAI Drug Coverage | Blue Cross and Blue Shield of Illinois. - BCBSIL {0c8Lp~#g.wS,#.z (c PT+ ~"%V3xCh`q'cgI$i%0!J"Cd"$| wFx&U K>txE |3Z$IJri]d(I,14)ze49E]'o|E1F |o%BIwF=";v=sN&./"G0'89)JuJ.v@FiS_$.xpP*GMG"g'K;KmVGA?7nW/pJ'3P.u'7y*6#E!LbC?hhCp6 4y%CS"R;%j)`y31pc`{%w)/*5hKE7:KRnQ&C+grc-pG`3P8+C~J7X 3o'YBa@sOz0zRlA_>]B]]#@W)o)|CNogbC;, jXw8w;![@0\bBJh1e8M'Z9owf;CYP[Hk`|8 (d/v_59=_O~o=pn[3f5+@tn0M|!ev"]"A!^A cc=zZf` sDH- rst !-`*M68G#gYmw/|O|)- What is the longest historic site trail in Wetter? BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. Registration is required. The ASAM Criteria, 2021 American Society of Addiction Medicine. Blue Cross Community MMAI has strict rules about how decisions are made about your care. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SMMake Decisions for Prior Authorizations? You can find out if your drug has any added conditions or limits by looking at the Drug List. These tools used by PCPs (or specialists) include medical codes. Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. In addition, some sites may require you to agree to their terms of use and privacy policy. Once additional meetings are confirmed, well alert you via the News and Updates. 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. 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. Lunch will be provided. This new site may be offered by a vendor or an independent third party. We know you like to plan ahead. Procedure code lists are provided for reference purposes. At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. 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. Click here to see prior authorization tools, clinical review criteria and MMAI Medical Policies used by your doctor to make a decision. File is in portable document format (PDF). 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 Your Summary of Benefits has information about which services require prior authorization. Some benefit plans administered by BCBSIL, such as some self-funded employer plans or governmental plans, may not utilize BCBSIL Medical Policies. 2. Medicaid Providers: Updated Prior Authorization Tips and Peer-to-Peer Information on Service Authorization Disputes can be found on the Provider Service Authorization Dispute Resolution Request Form. 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. New User? Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members. In addition, some sites may require you to agree to their terms of use and privacy policy. Medical Policies are based on scientific and medical research. Stage 3 of the long-distance hiking trail WestfalenWanderWeg, North Rhine-Westphalia. Provider Finder. Wetter - Kupferdreh Ruhrradweg | Map, Guide - North Rhine-Westphalia Copyright document.write(new Date().getFullYear()); Health Care Service Corporation. PDF Medicare-Medicaid Alignment Initiative (MMAI) Demonstration Frequently Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Our doctors and staff make decisions about your care based on need and benefits. Request a new replacement member ID card, or download a temporary copy. Non-Discrimination Notice. Drug Coverage. This new site may be offered by a vendor or an independent third party. All Rights Reserved. Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. The site may also contain non-Medicare related information. Home BCBSIL Provider Manual | Blue Cross and Blue Shield of Illinois Who is responsible for getting the prior authorization? Explore Out-of-Network Coverage for more information about your network. This new site may be offered by a vendor or an independent third party. This list includes generic and brand drugs and medical supplies. To ask for instructions on how to appeal, call the Member Services line for the MMAI plan or call the Senior HelpLine and ask for the MMAI Ombudsman at 1-800-252-8966 (TTY users should call 1-888-206-1327) Monday-Friday 8:30 am-5pm. Prior Authorization Support Materials (Government Programs) - BCBSIL Customer Service: File the dispute by calling Customer Service at 1-877-860-2837. Medicaid Providers: Updated Prior Authorization Tips and Peer - BCBSIL Qf#yQ>u(KpRE{UIQp[)5T:p:jBFp*WWhwIA36YwNG)!G/!Yr6v7e|12 rUp3?R1H-6Kre vh) yj?O&y]\x,$aU7Mm'a 5a1owahiT@IC+ 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. Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. Please see Drug Information for more information. }&ji[@_{dsTchsqD7bL+x3AXG>z>(y{+/en6=V/e{.t&>jFj750hS) !yppH7edMUFA{u38_tZ'oKAlr, @qiD The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. Availity provides administrative services to BCBSIL. 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. The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. 0 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 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. External link You are leaving this website/app (site). One option is Adobe Reader which has a built-in reader. From Essen-Kupferdreh back with the S-Bahn to the main station and from there without changing with the RE 16 back to Siegerland. You are leaving this website/app ("site"). 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. Register Now. Most PDF readers are a free download. Welcome. Where: Hybrid, Join us in person: 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. R'sYI D@ zmG@5msm!T%FN3_z. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Your plan covers the items in the Drug List as long as you: To see your plan's Drug List, go toForms & Documents. Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. Prior Authorization Support Materials (Government Programs) - BCBSIL
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