BCBSIL Modifies Some Preauthorization Requirements

BCBSIL Modifies Some Preauthorization Requirements

As you may have noticed in the December 2020 BlueReview, Blue Cross and Blue Shield of Illinois (BCBSIL) announced changes to the City of Chicago and Indian Prairie School District plans.  In response to ICS’ inquiry, BCBSIL has confirmed that, beginning on January 1, 2021, Orthonet will no longer handle preauthorization for any BCBSIL plans.

Here are the details found in the BCBSIL announcements:

Indian Prairie School District Plans:

  • On January 1, 2021, chiropractic services do not require prior authorization.

City of Chicago Plans (specific plans):

  • Beginning January 1, 2021, Telligen will handle prior authorization requirements for physical medicine services (including chiropractic and physical therapy) for some City of Chicago plans.
  • According to the BlueReview, the change applies to “BCBSIL member ID prefix CTY and group numbers 189421 and 189422” only. However, BCBSIL advised the ICS that this requirement impacts other City of Chicago plans including 195500, 195501, and 195502.
  • As the announcement reads, chiropractic physicians treating patients under group plan numbers 189421 and 189422 will have to obtain preauthorization from Telligen for physical therapy services following the 7th visit.
  • If you offer home physical therapy treatment, these services will require authorization beginning on the first visit.
  • The announcement did not address chiropractic services specifically for group numbers 189421 and 189422, nor group numbers P68263, P68265, P68266. However, BCBSIL clarified that these preauthorization requirements would apply to chiropractic services for the 189421 and 189422 and possibly other City of Chicago Plans. We recommend chiropractic physicians verify benefits through Availity.

You can view the announcement from the BlueReview by clicking on the section headings above. Also, we recommend protecting your City of Chicago billings by verifying benefits through Availity prior to service to determine if preauthorization is required.

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ICS Staff

The Illinois Chiropractic Society staff works collaboratively on many topics to bring the most comprehensive and relevant information to our members. We have over 60 years of chiropractic experience and understand the heartbeat of the profession. We all look forward to providing relevant information to our members for years to come.

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