Specialty Pharmacy Infusion Site of Care: Benefit Preauthorization Requirements
Posted October 1, 2018
Effective Jan. 1, 2019, benefit preauthorization will be required for select infusion drugs for the Blue Cross and Blue Shield of Illinois (BCBSIL) members in the networks listed below. These are drugs that are administered by health care professionals and typically covered under the member’s medical benefit.
- Blue Choice Preferred PPOSM
- Blue OptionsSM
- Blue PPOSM
Starting on Jan. 1, 2019, if you are prescribing these select infusion drugs, you will need to submit a benefit preauthorization request to BCBSIL prior to administration of the drug. To request benefit preauthorization, use our online tool, iExchange®. You may also call the number on the member’s BCBSIL ID card for assistance.
Please note that the fact that a service has been preauthorized 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.
iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.