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Alert: Extending Prior Authorization on Previously-Approved Elective Surgeries, Procedures and Therapies

Posted May 14, 2020

As previously announced on April 6, Blue Cross and Blue Shield of Illinois (BCBSIL) is temporarily extending approvals on services with existing prior authorizations until Dec. 31, 2020. This applies to services that were originally approved or scheduled between Jan. 1, 2020 and June 30, 2020 (previously April 1, 2020). This accommodation now also includes behavioral health in addition to most non-emergent, elective surgeries, procedures, therapies and home visits.

A member may reschedule an approved procedure to a later date in 2020 without a new prior authorization. This applies only to active members for a benefit that is covered under their plan at the time services are rendered. Check member eligibility and benefits through Availity® or your preferred vendor web portal prior to the scheduled procedure. Eligibility and benefit quotes include membership status, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts.

We will continue to monitor the national health emergency and will update as appropriate.

Details

  • BCBSIL will honor all BCBSIL prior authorizations on non-emergent surgeries, procedures, therapies, home visits and behavioral health services approved or scheduled between Jan. 1, 2020, and June 30, 2020 (previously April 1, 2020).
  • These prior authorizations will remain approved through Dec. 31, 2020. Approved services can be rescheduled with the authorized provider any time before Dec. 31, 2020, based on provider availability
  • Therapy sessions and home visits authorized for a specific number of occurrences between Jan. 1, 2020, and June 30, 2020 (previously April 1, 2020), will have the same number of occurrences available to an eligible member through the end of the year.
  • These rules apply to current members for a benefit that is currently covered under their plan.

Is this for all members?
These prior authorization extension changes apply to all PPO and Blue Choice PPOSM and Medicare Advantage members. It does not apply to HMO members. BCBSIL will continue to follow guidance from the Illinois Department of Healthcare and Family Services (HFS) and Centers for Medicare & Medicaid Services (CMS) with regard to benefit prior authorizations for Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM plans.

What You Need to Do
You do not need to do anything to extend an authorization. It will be automatically extended. Please notify us when services subject to a prior authorization are rendered. For inpatient admissions, let us know when one of our members is admitted to your facility.

Excluded Prior Authorizations
Prior authorizations for specialty medications are not extended. You must submit a new request for specialty medications.

Additional Services or Sessions
If a member seeks additional services or sessions, you must submit a new prior authorization request to BCBSIL for those additional services or sessions.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s 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. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.