Aim specialty health anthem bcbs11/22/2023 2023 Commercial Specialty Pharmacy Prior Authorization Drug List.2022 Commercial Outpatient Medical Surgical Prior Authorization Code List.2023 Commercial Outpatient Medical Surgical Prior Authorization Code List.2022 Commercial Prior Authorization Requirements Summary.2023 Commercial Prior Authorization Requirements Summary.Summary and Code Lists: Use the links below to review the full list of services and drugs that require prior authorization, click below to download a copy of the spreadsheet. The date you’ll receive service and the estimated length of stay (if you are being admitted).The proposed treatment plan, including any diagnostic or procedure codes (your provider can help you with these). Information about your medical or behavioral health condition.Your provider’s name, address and National Provider Identifier (NPI). Your name, subscriber ID number and date of birth.We need the following information to complete a prior authorization request: This review does not replace the advice of your provider. What Happens During the Prior Authorization Process?īCBSIL reviews the requested service or drug to find out if it’s medically necessary and appropriate for your needs. Our Customer Service will help you begin the process. Call the number listed on your BCBSIL member ID card. If your health care provider has not requested prior authorization, you can request it. How You Can Request Prior AuthorizationĬheck with us to find out if your provider has requested prior authorization before you get any services. You or your provider can request a renewal of a prior authorization up to 60 days before it expires.īCBSIL contracts with outside vendors, including Carelon Medical Benefits Management® (Carelon), eviCore® healthcare and Magellan Healthcare for certain prior authorization services. To make sure your provider is in-network, check our find care tool. If your providers aren’t in-network, you’ll be responsible for getting the prior authorization. But, it’s always a good idea to check if your providers have the needed approval. Usually, your health care providers will take care of prior authorization before they perform a service. These terms all refer to the requirements that you may need to meet before treatment may begin. This is called prior authorization, preauthorization, pre-certification or prior approval. 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. We use evidence-based clinical standards of care to make sure you get the health care you need. Recommended Clinical Review (Predetermination).If you choose to do business with this business, please let the business know that you contacted BBB for a BBB Business Profile.Īs a matter of policy, BBB does not endorse any product, service or business.Utilization management is at the heart of how you access the right care, at the right place and at the right time. BBB Business Profiles are subject to change at any time. When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints.īBB Business Profiles generally cover a three-year reporting period. However, BBB does not verify the accuracy of information provided by third parties, and does not guarantee the accuracy of any information in Business Profiles. BBB asks third parties who publish complaints, reviews and/or responses on this website to affirm that the information provided is accurate. BBB Business Profiles may not be reproduced for sales or promotional purposes.īBB Business Profiles are provided solely to assist you in exercising your own best judgment.
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