Blue Review
A newsletter for contracting institutional and professional providers

September 2020

Illinois Medicaid Claim Filing Tip: Include the Prior Authorization Number

This notice applies to providers who submit claims to Blue Cross and Blue Shield of Illinois (BCBSIL) for our Illinois Medicaid members. This includes our members with either of the following benefit plans: Blue Cross Community MMAI (Medicare-Medicaid)SM or Blue Cross Community Health PlansSM (BCCHPSM).

When prior authorization is required, it must be obtained before the service is performed. Prior authorization numbers are assigned by the payer or Utilization Management Organization (UMO) to confirm that necessary review has been completed and benefits have been approved for coverage.

Illinois Medicaid providers should include the assigned prior authorization number when submitting the claim for services rendered. Inclusion of this number will help ensure timely and accurate processing of the claim.

For electronic Professional and Institutional claims (837P and 837I transactions):

  • If the prior authorization number is applicable for all services rendered on the claim, it should be included in the 2300 Loop, REF02 element with the G1 qualifier in REF01.
  • If the prior authorization number is applicable to a single service line on the claim, it should be submitted in the 2400 Loop, REF02 element with the G1 qualifier in REF01.

For paper claims:
The prior authorization number should be submitted in Box 23 of the CMS-1500 Professional claim form and in Field 63 of the UB-04 Institutional claim form.