Update: New Benefit Preauthorization Requirements through eviCore
Posted June 28, 2016 (Updated Sept. 23, 2016*)
*As of Sept. 26, 2016, providers will be able to contact eviCore to request preauthorization for dates of service on and after Oct. 3, 2016, for outpatient molecular and genomic testing and outpatient radiation therapy. You can reach eviCore at evicore.com or toll-free at 855-252-1117. Access to eviCore healthcare’s preauthorization call center is available from 7 a.m. to 7 p.m. Monday through Friday.
Effective October 3, 2016, Blue Cross and Blue Shield of Illinois (BCBSIL) has contracted with eviCore healthcare (eviCore) to provide benefit preauthorization services for Blue Choice PPOSM, Blue Choice Preferred PPOSM and PPO for select services.
eviCore will manage benefit preauthorization for outpatient molecular and genetic tests and radiation oncology for dates of service beginning October 3, 2016. Services performed without benefit preauthorization may be denied for payment.
You will continue to use iExchange® for all other services that require a benefit preauthorization.
Both BCBSIL and eviCore will be providing additional information, including training opportunities, in the coming months on our Provider website and in Blue Review. You may also contact your Provider Network Consultant for more information.
eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL.
Please note that the fact that a service has been preauthorized/pre-certified 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.