Blue Review
A newsletter for contracting institutional and professional providers

May 2019

Check Your Patients’ Behavioral Health Benefit Preauthorization Requirements

Beginning July 15, 2019, we will be updating our 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 Provider 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.