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BLUE REVIEWSM

for Providers

December 2023

BlueApprovRSM Now Accepts Recommended Clinical Reviews for Behavioral Health

Blue Cross and Blue Shield of Illinois continues to streamline the pre-service review process to reduce your workload with BlueApprovR. This tool, accessible in Availity® Essentials, now processes optional recommended clinical reviews for behavioral health services, in addition to medical and surgical services and pharmacy drugs for many of our commercial, non-HMO members.

Here’s how to submit RCR and prior authorization requests with BlueApprovR:

Note: Your RCR submissions will follow the same path through BlueApprovR as prior authorization requests. Also, your RCR submission via BlueApprovR replaces the need to fax or to attach forms in Availity.

Remember: Member benefits vary based on the service being rendered and individual and group policy elections. Always check eligibility and benefits first through Availity or your preferred web vendor. This step will confirm coverage and other important details, such as prior authorization requirements and utilization management vendors, if applicable. For a list of services for which recommended clinical review is available, see our Recommended Clinical Review (Predetermination) Code List.

BlueApprovR Tool Offers End-to-End Efficiencies
Registered Availity Essentials users have free, 24/7 access to BlueApprovR tool to:

Provider Training
 Join us this month for an instructor-led, free webinar to learn how to use BlueApprovR. To register, select your preferred date and time from the list below. Times listed are Central Time:

You can use BlueApprovR to request prior authorization or RCR for these types of care:

Other Prior Authorization Request Methods
 If you’re not a registered Availity Essentials user, register today on Availity.com. Otherwise, you still may request prior authorization by calling the number on the member’s BCBSIL ID card.

Provider Resources
 See our BlueApprovR page for a user guide, instructional videos and other information. Also continue to watch the News and Updates for future program updates and training opportunities.

This tool is currently not available for Federal Employee Program®, Medicare Advantage, Illinois Medicaid, or any of our HMO members. Please use your existing process for requesting prior authorization reviews for these members.

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Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations 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. BCBSIL makes no endorsement, representations, or warranties regarding third party vendors and the products and services they offer.