January 2019

Behavioral Health Benefit Preauthorizations for City of Chicago Employees

Blue Cross and Blue Shield of Illinois’ (BCBSIL) Provider Relations team is committed to helping you stay aware of changes and trends that may have an impact on your business. The City of Chicago (three-character member ID prefix: CTY) has implemented changes for employees who are BCBSIL members that affect outpatient behavioral health and outpatient substance abuse services.

City of Chicago employees who receive outpatient behavioral health or outpatient substance abuse services are covered for up to seven visits in one year before utilization review is required. Members who have received seven outpatient services in one year will need benefit preauthorization for additional visits, which providers can obtain by contacting the medical advisor, Telligen, prior to the eighth visit. Please note that the seven visits before benefit preauthorization is needed per member, not per provider. Thus, if the member has received services from another behavioral health or substance abuse provider prior to coming to you for treatment, benefit preauthorization may be needed before their initial visit with you.

You can reach Telligen at 800-373-3727 or visit their Provider Portal.

Questions may be directed to ProviderRelations@bcbsil.com, or by contacting your Provider Network Consultant (PNC). Services that are not preauthorized will not be paid and will be the financial responsibility of the provider. Members may not be charged for services that were not preauthorized.

BCBSIL cares about connecting behavioral health patients with an outpatient provider within 30 days of discharge from an inpatient stay. For more information about our Behavioral Health program, visit the Behavioral Health Program page. The latest Healthcare Effectiveness Data and Information Set (HEDIS^®) results can be found on the Quality Improvement page, under HEDIS. 

Telligen is an independent company that provides Utilization Review/Case Management/Disease Management/Maternity Management to BCBSIL. Telligen is wholly responsible for its own products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by Telligen.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

Checking eligibility and benefits and/or obtaining preauthorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.