We're 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 Plans SM (BCCHP) members. To view this file, you may need to install a PDF reader program. Out of area dialysis services. The next highest ascent for historic site trails is Von Wetter zum Nacken with 664 m of elevation gain. For other services/members, BCBSIL has contracted with eviCore healthcare (eviCore) for utilization management and related services. 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. Search for doctors, dentists, hospitals and other health care providers. Your doctor will need to request approval before these drugs can be prescribed. The ASAM Criteria, 2021 American Society of Addiction Medicine. During weekend hours, UM reviewers and medical directors continue to review requests and make decisions. It also includes the drugs covered by Medicare Part D. As a member, you have no copay for covered items on the Drug List. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. One option is Adobe Reader which has a built-in screen reader. You also have the right to ask for a coverage decision. Aurora, IL 60506. You are leaving this website/app ("site"). <> To view this file, you may need to install a PDF reader program. MMAI Drug Coverage | Blue Cross and Blue Shield of Illinois. - BCBSIL 2 0 obj 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. File is in portable document format (PDF). Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. 373 0 obj <> endobj Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. Some benefit plans administered by BCBSIL, such as some self-funded employer plans or governmental plans, may not utilize BCBSIL Medical Policies. You can get one shipment every three months. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. April 24, 2023. 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. New User? Registration is required. We also feature guest speakers and allow time for a general Q&A. Medical Policies are based on scientific and medical research. In addition, some sites may require you to agree to their terms of use and privacy policy. According to AllTrails.com, the longest historic site trail in Wetter is RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen. This link will take you to a new site not affiliated with BCBSIL. 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 Most PDF readers are a free download. The site may also contain non-Medicare The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. 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 . 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. Information provided is not exhaustive and is subject to change. Your doctor should know which services need approval and can help with the details. Grievance (Complaint) Appeals Always check eligibility and benefits through Availity or your preferred web vendor before rendering services. 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 Reminder: Hospital 30-day Readmission Review Process for BCCHP and MMAI The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. This new site may be offered by a vendor or an independent third party. Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. These requests must be decided within 48 hours for BCCHP members, and 72 hours for MMAI members. If you want to know more about the utilization management process or how decisions are made about your care, Contact Us. k+:6@1)^]WNQj sGG& hFa`@,%LFPBA7Xmxt$.=e0ne}#IoE 20iF 6Xg8Sf;+-P > BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Those exceptions are: Emergency care or urgently needed care. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider. 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. Explore Out-of-Network Coverage for more information about your network. Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Providers are instructed to exercise their own clinical judgment based on each individual patients health care needs. 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. All Rights Reserved. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. Please see Drug Information for more information. Provider | Blue Cross and Blue Shield of Illinois - BCBSIL Topics include everything from improving your well-being to explaining health coverage. The peer-to-peer discussion is available as a courtesy to providers. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. See Chapter 4 of theMember Handbookon the Forms & Documents page for more details. 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. You are leaving this website/app (site). Out-of-Network Coverage. To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section. 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 Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) Sign up for theLifeTimes newsletterto get health and benefits articles delivered to your inbox every month. How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SMMake Decisions for Prior Authorizations? What: Q2 2023 MMAI and BCCHP Community Stakeholder Committee Meeting Join us as we build the next generation of health insurance. New User? Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. New to Blue Access for Members? Whats on the agenda? Customer Service: File the dispute by calling Customer Service at 1-877-860-2837. 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. In addition, some sites may require you to agree to their terms of use and privacy policy. Copyright 2021 Health Care Service Corporation. 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. 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. Search articles and watch videos; ask questions and get answers. You'll see details that may help lower health care costs. 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. This list includes generic and brand drugs and medical supplies. Out-of-Network Coverage | Blue Cross and Blue Shield of Illinois - BCBSIL The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Failing to provide clinical information or timely notification of prior authorization requests may affect the outcome of a Service Authorization Dispute. Limitations of Covered Benefits by Member Contract Utilization Management | Blue Cross and Blue Shield of Illinois - BCBSIL
