September 2020
iExchange® Deactivated on Aug. 17, 2020
Our previous electronic benefit preauthorization and predetermination of benefits request tool, iExchange, was deactivated on Aug. 17, 2020. As of this date, all electronic benefit preauthorization and predetermination of benefits requests handled by Blue Cross and Blue Shield of Illinois (BCBSIL) should be submitted online via the Availity® Provider Portal.
How to Submit Online Benefit Preauthorization Requests
Benefit preauthorization requests for inpatient admissions and select outpatient services handled by BCBSIL may be submitted online using Availity’s Authorizations tool. For navigational assistance, refer to the educational Availity Authorizations User Guide, located in the Provider Tools section of our website. The process of submitting preauthorization requests to eviCore healthcare (eviCore) or other vendors has not changed.
Always check the patient’s eligibility and benefits online first to determine if the service requires preauthorization. For online help, refer to the General Eligibility and Benefits Expanded User Guide.
Submitting benefit preauthorization requests via Availity does not apply for our HMO members.
How to Submit Online Predetermination of Benefits Requests
Predetermination of benefits requests handled by BCBSIL may be submitted electronically in just four steps by using Availity’s Attachments tool. For instructions, see our Electronic Predetermination Request User Guide.
As a reminder, a predetermination of benefits is a voluntary request for written verification of benefits prior to rendering services. We recommend submitting a predetermination of benefits request if the service may be considered experimental, investigational or unproven, as specified within the BCBSIL Medical Policy.
Note: If you don’t have online access, you may continue to fax and/or mail predetermination of benefit requests along with a completed Predetermination Request Form and pertinent medical documentation.
The predetermination of benefits information above does not apply to requests for HMO, Illinois Medicaid or Medicare Advantage members.
For More Information
You must be registered with Availity to use the Authorizations and Attachments tools. Sign up today for free at Availity. For registration help, call Availity Client Services at 800-282-4548.
If you need further help or customized training for these Availity solutions, contact our Provider Education Consultants.
Please note that the fact that a service has been preauthorized/pre-notified, that a guideline is available for any given treatment or that a service or treatment has been predetermined for benefits, 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, 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. eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. eviCore is wholly responsible for its own products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, eviCore or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.