Jan. 23, 2020
Effective March 1, 2020, some Blue Cross and Blue Shield of Illinois (BCBSIL) members in Texas will have new prior authorization requirements through eviCore healthcare (eviCore)®. The members affected have the following three-character prefixes in front of their ID number:
Services Requiring Prior Authorization
The new prior authorization requirements through eviCore, for these prefixes, apply to the following outpatient services:
- Advanced Imaging
- Genetic Testing
- Joint and Spine Surgery
- Pain Management
- Radiation Therapy
- Sleep Studies
There are two ways to secure a prior authorization through eviCore:
- Online — The eviCore web portal is the quickest way to open a case, check status, review guidelines and more.
- By phone — Call eviCore at 1-855-252-1117 between 7 a.m. and 7 p.m. (CST), Monday through Friday.
Requirements Vary by Member
Prior authorization requirements are specific to each member based on their benefit plan. Check eligibility and benefits before rendering services. Submitting an electronic 270 transaction via the Availity® Provider Portal or your preferred vendor portal provides information about:
- Network status
- Prior authorization requirements
- Other important details
Obtaining benefit prior authorization is not a substitute for checking eligibility and benefits. We will not pay for services performed without the required benefit prior authorization. Providers may not seek reimbursement from our members. If you have any questions, contact 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 BCBSTX. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity or eviCore. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits 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 questions, contact the number on the member’s ID card.