You pay nothing ($0) when you go to a doctor or health care provider in the plan's network. One option is Adobe Reader which has a built-in screen reader. Frequently asked questions about historic site trails in Wetter. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice, Have a prescription from your doctor for them, Fill the prescription at a network pharmacy. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. 2 0 obj Prior Authorization Support Materials (Government Programs). Registration is required. We know you like to plan ahead. New to Blue Access for Members? Certain drugs on the list need prior authorization. Provider Finder. Your plan covers the items in the Drug List as long as you: To see your plan's Drug List, go toForms & Documents. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Availity provides administrative services to BCBSIL. R{O *L%U}r?:B22Rj=]p ($c j `-g [W}]blE&rT}TmPi]`8*I/,%,((56eA lLlkFy_&df4]`)`m9lrSQHp*:Y0T"NEAu:",@vR8za7nn7I,Iz-rSroq@T#}MW *7I :=C;hEQQq_1d"A B M$ }u$z Refer to our Medicaid prior authorization summary for more details. Lunch will be provided. Legal and Privacy %PDF-1.6 % One option is Adobe Reader which has a built-in reader. Grievance (Complaint) Appeals Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. You can: Pay a bill online or sign up for auto bill pay. option is Adobe Reader which has a built-in reader. For other services/members, BCBSIL has contracted with eviCore healthcare (eviCore) for utilization management and related services. The next highest ascent for historic site trails is. To view this file, you may need to install a PDF reader program. hb```) ea&pd:Se 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 . 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. However, you can order these items once every three months. You are leaving this website/app ("site"). 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. Well also include reminders in the Blue Review. You also can call the MMAI plan's pharmacy help-line. See below for details, including the Zoom registration link. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. New User? This list includes generic and brand drugs and medical supplies. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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. To return to our website, simply close the new window. 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. If no clinical information was submitted with a request, a peer-to-peer discussion is not permitted. {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|)- Information provided is not exhaustive and is subject to change. If you do not use the $30, it does not roll over into the next three months. 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 Out of area dialysis services. *Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. stream The tool returns a list of services that may require prior authorization through BCBSIL or eviCore healthcare (eviCore) for BCCHP and MMAI members. `9wL Procedure code lists are provided for reference purposes. Sara will be discussing Mental Health Awareness Month and cultural competency. endstream endobj startxref Highlights: Our guest speaker is Sara Gray, Executive Director of National Alliance on Mental Illness, Kane-south, DeKalb and Kendall Counties. We also feature guest speakers and allow time for a general Q&A. %%EOF Most PDF readers are a free download. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. This new site may be offered by a vendor or an independent third party. 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. Our trusted community experts can give you the one-on-one help you need to shop for health insurance. Who is responsible for getting the prior authorization? According to AllTrails.com, the longest historic site trail in Wetter is. File is in portable document format (PDF). The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. For some services/members, prior authorization may be required through BCBSIL. Government Programs Prior Authorization Summary and Code ListsRefer to the Summary documents below for an overview of prior authorization requirements, reminders and helpful links. 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. At Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, we take great pride in ensuring that you receive the care you need. This new site may be offered by a vendor or an independent third party. All Rights Reserved. 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. 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. 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. Wed like to invite you to join us for our next committee meeting on May 18, 2023. This link will take you to a new site not affiliated with BCBSIL. But we know its nice to have other ways to view prior authorization information, too. Search articles and watch videos; ask questions and get answers. Most PDF readers are a free download. <> It also includes the drugs covered by Medicare Part D. As a member, you have no copay for covered items on the Drug List. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice. 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. GDChv0O{Q~ $W0!&~(c~;=1^!GD=q2z5OR%AG.)H&lz'9|^f!(@.ib Members should contact the vendor(s) directly with questions about the products or services offered by third parties. 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). In addition, some sites may require you to agree to their terms of use and privacy policy. During weekend hours, UM reviewers and medical directors continue to review requests and make decisions. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. 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. Simply enter a 5-digit code, service description or drug name in the search field. BCBSIL adheres to the standards for addressing all urgent concurrent requests, meeting or exceeding National Committee for Quality Assurance (NCQA) standards. Talk with your doctor about your medication. Welcome. Prior authorization requests for administrative days (ADs) may not be submitted online at this time. 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. hbbd```b``6O L %,"&*u`0;L:`5 ; URGENT (If checked, please provide anticipated date of service below) If a request does not meet medical necessity criteria for approval, the request will be assigned to a BCBSIL medical director for determination. Medical policies are also used to guide care decisions. If an appeal has been filed, the peer-to-peer discussion is no longer available. For some drugs, the plan limits the amount that will be covered. 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. 6C("=L,`YF'0 d At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. The table below contains some of the services covered under your plan. Search for doctors, dentists, hospitals and other health care providers. Where: Hybrid, Join us in person: Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. 1 0 obj Log In to the Shopping Cart, Need to Make a Payment? For more information, refer to the 2021 Medicaid Prior Authorization Requirements Summary and 2021 Medicaid Prior Authorization Code List available in the Medicaid section on the Support Materials (Government Programs) page. 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. In addition, some sites may require you to agree to their terms of use and privacy policy. There are some exceptions when care you receive from an out-of-network provider will be covered. 101 S. River Street Your PCP will handle the prior authorization process. File is in portable document format (PDF). The site may also contain non-Medicare related information. You'll see details that may help lower health care costs. Most PDF readers are a free download. Davis Vision is an independent company that has contracted with BCBSIL to provide vision benefits administration for government programs members with coverage through BCBSIL. The next highest ascent for historic site trails is Von Wetter zum Nacken with 664 m of elevation gain. 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. 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. Recently, we added a digital lookup tool that gives you a different way to view prior authorization requirements that may apply to our BCCHP and MMAI members. The Customer Service representative will provide you a reference number, which can be used to track the dispute. To view this file, you may need to install a PDF reader program. 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. ALLTRAILS and the AllTrails Mountain Design are registered trademarks of AllTrails, LLC in the United States as well as certain other jurisdictions. <>/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>> The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois (BCBSIL) government programs members enrolled in any of the following plans: 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. These requests must be decided within 48 hours for BCCHP members, and 72 hours for MMAI members. Get the most from your BCBSIL pharmacy benefits. Stay informed about BCBSIL programs, products, initiatives, and more. File is in portable document format (PDF). Medical Policies are based on scientific and medical research. 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. To support the decision process, BCBSIL gives providers the opportunity to discuss UM determinations with a peer physician. These tools used by PCPs (or specialists) include medical codes. For more than 85 years, weve provided our members with comprehensive, affordable health plans, making Illinois a healthier place to live, work and play. Always check eligibility and benefits through Availity or your preferred web vendor before rendering services. Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the conditions of the patient in determining the appropriate course of treatment. You are leaving this website/app (site). From Siegen with the beautiful day ticket (33 euros for 5 people) to Wetter / Ruhr. 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. 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. Qf#yQ>u(KpRE{UIQp[)5T:p:jBFp*WWhwIA36YwNG)!G/!Yr6v7e|12 rUp3?R1H-6Kre vh) yj?O&y]\x,$aU7Mm'a 5a1owahiT@IC+ The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. <> This list includes generic and brand drugs and medical supplies. You also have the right to ask for a coverage decision. Luckily, your health insurance can change with you. Checking eligibility and benefits through Availity Essential or your preferred web vendor is always the best place to start, before you provide care and services to any of our members. If you want to know more about the utilization management process or how decisions are made about your care, Contact Us. This step also helps you identify prior authorization requirements and utilization management vendors, if applicable. Non-Discrimination Notice. For some services/members, prior authorization may be required through BCBSIL. The ASAM Criteria, 2021 American Society of Addiction Medicine. April 24, 2023. You can find out if your drug has any added conditions or limits by looking at the Drug List. Clear and timely submission of prior authorization requests and clinical documentation is very important to process requests within the required timeframes. Choose the best payment option for your Blue Cross and Blue Shield of Illinois (BCBSIL) monthly bill. 0 Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. For some services/members, prior authorization may be required through BCBSIL. Whens the meeting for the next quarter? (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). 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. Personal health-related items (such as a toothbrush and toothpaste) are not included on this list. 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. The site may also contain non-Medicare 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. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Please note that, effective May 1, 2021, there will be a change to the BCCHP peer-to-peer discussion process, as specified below. From Essen-Kupferdreh back with the S-Bahn to the main station and from there without changing with the RE 16 back to Siegerland. Sign up! 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. Why participate? Your doctors will use other tools to check prior authorization needs. 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. External link You are leaving this website/app (site). They use what is called clinical criteria to make sure you get the health care you need. MCG (formerly Milliman Care Guidelines) is a trademark of MCG Health, LLC (part of the Hearst Health network), an independent third party vendor. See Chapter 4 of theMember Handbookon the Forms & Documents page for more details. Request a new replacement member ID card, or download a temporary copy. Which historic site trail has the most elevation gain in Wetter? For other services/members, BCBSIL has contracted witheviCore healthcare (eviCore)for utilization management and related services. The site may also contain non-Medicare related information. All Rights Reserved. If you have a complaint about how we handle any services provided to you, you can file a grievance or an appeal. The site may also contain non-Medicare related information. Copyright document.write(new Date().getFullYear()); Health Care Service Corporation. One option is Adobe Reader which has a built-in screen reader. You must indicate that you want to file a claims dispute. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. 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. Santori Library 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 3 0 obj Once additional meetings are confirmed, well alert you via the News and Updates. How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SMMake Decisions for Prior Authorizations? % FIND YOUR WAY OUTSIDE is a trademark of AllTrails, LLC. One option is Adobe Reader which has a built-in reader. New User? 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. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. YDLmW~/Pi_7wRwN]_RwMFrg~ w BJA9V)F:C5F7\(]U{8-KBC T.~mj mBlw~ C5?eja3\p0FooS"_iNQq9;H`76 97hQsD0O8IL*]"w}mP2H#^mHqMD[kn>iE7T" + {pxk4(uN7Lmgw5oCOa1 DV. 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. endobj DentaQuest is an independent company that provides dental benefits for BCBSILs Medicaid plans. The plan will pay up to $30 (plus $5 for shipping) for each order. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. 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. What is the longest historic site trail in Wetter? Doctors are not paid to deny care. For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. 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. Our doctors and staff make decisions about your care based on need and benefits. Providers are instructed to exercise their own clinical judgment based on each individual patients health care needs. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. For BCCHP and MMAI: Peer-to-peer discussions are allowed for requests where clinical information was submitted with the original request. The peer-to-peer discussion is available as a courtesy to providers. Returning Shopper? 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. 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. There are no rewards to deny or promote care. External link You are leaving this website/app (site). From the train station through the underpass, it goes straight across the street to the Ruhr cycle path. 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 <. 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. What is the most popular and difficult historic site trail in Wetter? Your doctor will choose which drug is best for you. endstream endobj 374 0 obj <. Log in to your account to get the most accurate, personalized search results based on your plan. When: Thursday, May 18, 2023, from 1 to 2:30 p.m. CST Some services need approval from your health plan before you get treated. All Rights Reserved. Medicaid Prior Authorization Request Form, Provider Service Authorization Dispute Resolution Request Form. References to other third party sources or organizations are not a representation, warranty or endorsement of such organizations. Topics include everything from improving your well-being to explaining health coverage. Copyright 2021 Health Care Service Corporation. related information.