A provider may initiate a peer-to-peer discussion by calling 800-981-2795. Members should contact the customer service number on their member ID card for more specific coverage information. It will open in a new window. This new site may be offered by a vendor or an independent third party. Get the most from your BCBSIL pharmacy benefits. This new site may be offered by a vendor or an independent third party. For some drugs, the plan limits the amount that will be covered. %PDF-1.6
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Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. 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. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
You'll see details that may help lower health care costs. All Rights Reserved.
In addition, some sites may require you to agree to their terms of use and privacy policy. The peer-to-peer discussion is not required, nor does it affect the providers right to an appeal on behalf of a member. URGENT (If checked, please provide anticipated date of service below) #5 - RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, #6 - WestfalenWanderWeg Etappe 3: Wetter - Schwerte. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.)
The next highest ascent for historic site trails is Von Wetter zum Nacken with 664 m of elevation gain. 4 0 obj
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 protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. For other services/members, BCBSIL has contracted witheviCore healthcare (eviCore)for utilization management and related services. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. The digital lookup tool is intended for reference purposes only. Davis Vision is an independent company that has contracted with BCBSIL to provide vision benefits administration for government programs members with coverage through BCBSIL. R{O *L%U}r?:B22Rj=]p
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M$ }u$z Additionally, the Provider Service Authorization Dispute process is available when an adverse service authorization has been rendered and the UM process has been followed. These tools used by PCPs (or specialists) include medical codes. Request a new replacement member ID card, or download a temporary copy. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. The Customer Service representative will provide you a reference number, which can be used to track the dispute. Availity provides administrative services to BCBSIL. Blue Cross Community MMAI has strict rules about how decisions are made about your care. Your feedback is vital to improving the care and services these members receive. Life changes happen at any time. 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. k+:6@1)^]WNQj sGG&
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Which historic site trail has the most elevation gain in Wetter? You are leaving this website/app (site). To return to our website, simply close the new window. Prior authorization requests for administrative days (ADs) may not be submitted online at this time. ALLTRAILS and the AllTrails Mountain Design are registered trademarks of AllTrails, LLC in the United States as well as certain other jurisdictions. Your PCP will handle the prior authorization process. 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. 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. Grievance (Complaint) Appeals <>/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>>
Your Summary of Benefits has information about which services require prior authorization. For some services/members, prior authorization may be required through BCBSIL. All Rights Reserved. If you have any questions, call the number on the members ID card. Related Resources 2 0 obj
This new site may be offered by a vendor or an independent third party. 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, 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). 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 . %PDF-1.7
Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Make Decisions for Prior Authorizations? For more than 85 years, weve provided our members with comprehensive, affordable health plans, making Illinois a healthier place to live, work and play. File is in portable document format (PDF). stream
Personal health-related items (such as a toothbrush and toothpaste) are not included on this list. All Rights Reserved. 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" Providers are allowed the opportunity to schedule one peer-to-peer discussion per adverse determination. Sometimes you may need to get approval from Blue Cross and Blue Shield of Illinois (BCBSIL) before we will cover certain inpatient, outpatient and home health care services and prescription drugs. Most PDF readers are a free download. 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. This approval is called "prior authorization." 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. What is the most popular and difficult historic site trail in Wetter? At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. If an appeal has been filed, the peer-to-peer discussion is no longer available. Whens the meeting for the next quarter? 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. Always check eligibility and benefits through Availity or your preferred web vendor before rendering services. Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. This step will help you confirm prior authorization requirements and utilization management vendor information, if applicable. Your plan does not encourage doctors to give less care than you need. But we know its nice to have other ways to view prior authorization information, too. 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. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. 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. In addition, some sites may require you to agree to their terms of use and privacy policy. MCG (formerly Milliman Care Guidelines) is a trademark of MCG Health, LLC (part of the Hearst Health network), an independent third party vendor. Whats on the agenda? hb``0b`0 36 fah@t#(f`XU1U B)xPB2@+4s\
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<. Aurora, IL 60506. 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. The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. From the train station through the underpass, it goes straight across the street to the Ruhr cycle path. Prior Authorization Support Materials (Government Programs). 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. Check out our Corporate Social Responsibility Reportto learn the ways we're serving our community. Once additional meetings are confirmed, well alert you via the News and Updates. endobj
To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section. Registration is required. One
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In most cases, you must receive your care from a Blue Cross Community MMAI (Medicare-Medicaid Plan) SM in-network plan provider. Without approval, the drug won't be covered. Step-by-Step Guide for Provider Finder. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Availity provides administrative services to BCBSIL. According to AllTrails.com, the longest historic site trail in Wetter is RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen. Some services need approval from your health plan before you get treated. Highlights: Our guest speaker is Sara Gray, Executive Director of National Alliance on Mental Illness, Kane-south, DeKalb and Kendall Counties. How to File a Claims Dispute using Enterprise Appeals Application (EAA) Tracking ID 1. This list includes generic and brand drugs and medical supplies. 3 0 obj
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. Refer to our Medicaid prior authorization summary for more details. 12 0 obj
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Certain drugs on the list need prior authorization. Search your plan's drug list, find a pharmacy, and more. Use the links below to view BCBSIL and vendor guidelines that may apply. 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. The health of your eyes and teeth can affect your overall health. Explore Out-of-Network Coverage for more information about your network. Our doctors and staff make decisions about your care based on need and benefits. endstream
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<. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes: Medical benefits such as coverage for preventive care services, emergency and urgent care coverage, diagnostic tests and more Behavioral Health benefits Prescription coverage Transportation Services to help you get to and from your appointments Dental care, eye care, and more Our doctors and staff make decisions about your care based only on need and benefits. 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. Your doctor will choose which drug is best for you. To view this file, you may need to install a PDF reader program. External link You are leaving this website/app (site). 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. See below for details, including the Zoom registration link. Its a great chance to work with faith leaders, advocacy groups and other community-based organizations that support our members health and well-being. 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. This list includes generic and brand drugs and medical supplies. Most PDF readers are a free download. What is the longest historic site trail in Wetter? 2. 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). 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. To view this file, you may need to install a PDF reader program. Members should contact the vendor(s) directly with questions about the products or services offered by third parties. You also can call the MMAI plan's pharmacy help-line. The tool returns a list of services that may require prior authorization through BCBSIL or eviCore healthcare (eviCore) for BCCHP and MMAI members. The code lists are posted as PDFs so you can scroll through pages manually or enter
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