Check Your Patients' Behavioral Health Benefit Preauthorization Requirements

Posted April 30, 2019

Beginning July 15, 2019, we will be updating our internal claims review process for behavioral health services that require benefit preauthorization. Your process for requesting benefit preauthorization is not changing. The services requiring benefit preauthorization are also not changing.

As a reminder, the behavioral health services listed below typically need benefit preauthorization.

• Services provided in the following settings:

◦ Inpatient acute facilities

◦ Residential treatment facilities

◦ Partial hospitalization

◦ Intensive outpatient therapy

◦ Focused outpatient management

• Psychological or neuropsychological testing

• Applied behavior analysis

Services performed without benefit preauthorization, if required, will be denied for payment and providers may not seek reimbursement from Blue Cross and Blue Shield of Illinois (BCBSIL) members.

For more information on behavioral health benefit preauthorization requirements, visit the Behavioral Health Program section of our website. You may submit benefit preauthorization requests online for Intensive Outpatient Program and Electroconvulsive Therapy using our online tool, iExchange®. Refer to our Forms page for behavioral health preauthorization requests and other forms.

You should always check eligibility and benefits for each member before treatment. This step will help you confirm applicable benefit preauthorization requirements. You may check eligibility and benefits online for BCBSIL, out-of-area Blue Plan and Federal Employee Program® (FEP®) members via the Availity® Provider Portal or your preferred vendor portal.

Checking eligibility and/or benefit information and/or 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. If you have any questions, please call 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 BCBSIL. 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 Availity or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.