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Wetter - Kupferdreh Ruhrradweg | Map, Guide - North Rhine-Westphalia Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM The Centers for Medicare & Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement MMAI. Whats new on the web? The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois (BCBSIL) government programs members enrolled in any of the following plans: Always check eligibility and benefits first through Availity or your preferred web vendor portal to confirm coverage and other important details, including prior authorization requirements and vendors, if applicable. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. How to File a Claims Dispute using Enterprise Appeals Application (EAA) Tracking ID 1. Its important to check eligibility and benefits first for each patient at every visit to confirm coverage details. {0c8Lp~#g.wS,#.z (c PT+ ~"%V3xCh`q'cgI$i%0!J"Cd"$| wFx&U K>txE |3Z$IJri]d(I,14)ze49E]'o|E1F |o%BIwF=";v=sN&./"G0'89)JuJ.v@FiS_$.xpP*GMG"g'K;KmVGA?7nW/pJ'3P.u'7y*6#E!LbC?hhCp6 4y%CS"R;%j)`y31pc`{%w)/*5hKE7:KRnQ&C+grc-pG`3P8+C~J7X 3o'YBa@sOz0zRlA_>]B]]#@W)o)|CNogbC;, jXw8w;![@0\bBJh1e8M'Z9owf;CYP[Hk`|8 (d/v_59=_O~o=pn[3f5+@tn0M|!ev"]"A!^A cc=zZf` sDH- rst !-`*M68G#gYmw/|O|)- Use the links below to view BCBSIL and vendor guidelines that may apply. Search articles and watch videos; ask questions and get answers. In most cases, you must receive your care from a Blue Cross Community MMAI (Medicare-Medicaid Plan) SM in-network plan provider. Log In to the Shopping Cart, Need to Make a Payment? Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com related information. What: Q2 2023 MMAI and BCCHP Community Stakeholder Committee Meeting In addition, some sites may require you to agree to their terms of use and privacy policy. Members should contact the vendor(s) directly with questions about the products or services offered by third parties. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Your doctor will choose which drug is best for you. All rights reserved. From Siegen with the beautiful day ticket (33 euros for 5 people) to Wetter / Ruhr. The code lists are posted as PDFs so you can scroll through pages manually or enter to search, highlight and advance to all instances of a particular word or number. The site may also contain non-Medicare related information. However, you can order these items once every three months. All Rights Reserved. The health of your eyes and teeth can affect your overall health. This list includes generic and brand drugs and medical supplies. Related Resources Access Your Payment Options. This trail is estimated to be 42.6 km long. Doctors are not paid to deny care. Registration is required. #5 - RuhrtalRadweg Etappe 4: Wetter (Ruhr) - Essen, #6 - WestfalenWanderWeg Etappe 3: Wetter - Schwerte. Medicaid Prior Authorization Request Form Please fax completed form to 312-233-4060 This information applies to Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. Most PDF readers are a free download. They use what is called clinical criteria to make sure you get the health care you need. 2023 Best Historic Site Trails in Wetter | AllTrails One option is Adobe Reader which has a built-in screen reader. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. We'd like to invite you to join us for our next committee meeting on May 18, 2023. To view this file, you may need to install a PDF reader program. New User? Lunch will be provided. You must indicate that you want to file a claims dispute. You are leaving this website/app (site). As you transition to Medicare, we hope you'll Stay with Blue and get Medicare coverage from a company you trust. All Rights Reserved. Some services need approval from your health plan before you get treated. For Medicaid (BCCHP and MMAI) members, prior authorization requirements are found in the last column of the BCCHP drug list and MMAI drug list. Most PDF readers are a free download. Getting Care Through MMAI | Blue Cross and Blue Shield of Illinois - BCBSIL Search for doctors, dentists, hospitals and other health care providers. The plan will pay up to $30 (plus $5 for shipping) for each order. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. But we know its nice to have other ways to view prior authorization information, too. endobj Medical policies are also used to guide care decisions. The BCBSIL Provider Manuals are comprehensive guides for Blue Cross Community Health Plans SM, Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, Blue Cross Medicare Advantage (HMO) SM, Blue Cross Medicare Advantage (PPO) SM, Blue Choice PPO SM, HMO, PPO and Blue High Performance Network (Blue HPN ) EPO professional and facility providers. To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs. ( Note: See Medicaid page for BCCHP and MMAI Provider Finder links.) The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Always check eligibility and benefits through Availity or your preferred web vendor before rendering services. Grievance (Complaint) Appeals How to request prior authorization: Prior authorization requests may be made by phone (call 877-860-2837 for BCCHP members, call 877-723-7702 for MMAI members) or by fax to 312-233-4060 (same fax number for BCCHP and MMAI). This new site may be offered by a vendor or an independent third party. Please note that, effective May 1, 2021, there will be a change to the BCCHP peer-to-peer discussion process, as specified below. The site may also contain non-Medicare Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Its a great chance to work with faith leaders, advocacy groups and other community-based organizations that support our members health and well-being. 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 members policy certificate and/or benefits booklet and or summary plan description. Learn about the many ways we are contributing to the well-being of our local Illinois communities in the latest Corporate Social Responsibility Report. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. Government Programs Prior Authorization Summary and Code ListsRefer to the Summary documents below for an overview of prior authorization requirements, reminders and helpful links. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Customer Service: File the dispute by calling Customer Service at 1-877-860-2837. Subscribe now to receive the monthly Blue Review via email. Whats on the agenda? Clinical Review Criteria Utilization management reviews use evidence-based clinical standards of care to help determine whether a benefit may be covered under the members health plan. The code lists are posted as PDFs so you can scroll through pages manually or enter <CTRL F> to search, highlight and advance to all . Limitations of Covered Benefits by Member Contract Pharmacy Benefit Prior Authorization Requirements Prime Therapeutics, our pharmacy benefit manager, conducts all reviews of prior authorization requests from physicians for BCBSIL members with prescription drug coverage. Out-of-Network Coverage | Blue Cross and Blue Shield of Illinois - BCBSIL MMAI Drug Coverage | Blue Cross and Blue Shield of Illinois. - BCBSIL Why participate? hbbd```b``nF`+d'lO0{d&WEV"8EVU9`"DaDa@6`4r lf|pwOIF@W; v#30^0 !X endstream endobj startxref 0 %%EOF 107 0 obj <>stream BCBSIL Provider Manual | Blue Cross and Blue Shield of Illinois Medicaid Providers: Updated Prior Authorization Tips and Peer - BCBSIL 415 0 obj <>stream Convey Health Solutions, Inc. is an independent company that provides administrative services for over-the-counter supplemental benefits for Blue Cross and Blue Shield of Illinois. Request a new replacement member ID card, or download a temporary copy. Sign up for theLifeTimes newsletterto get health and benefits articles delivered to your inbox every month. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. At Blue Cross Community MMAI (Medicare-Medicaid Plan) SM, we take great pride in ensuring that you receive the care you need. This step helps you confirm membership, coverage and other details, including prior authorization requirements and utilization management vendors. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Without approval, the drug won't be covered. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice, Have a prescription from your doctor for them, Fill the prescription at a network pharmacy. *Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Home To access the BCCHP and MMAI digital lookup tool, refer to the Prior Authorization Support Materials (Government Programs) page in our Utilization Management section. Our doctors and staff make decisions about your care based on need and benefits. In addition, some sites may require you to agree to their terms of use and privacy policy. It also includes the drugs covered by Medicare Part D. As a member, you have no copay for covered items on the Drug List. The Customer Service representative will provide you a reference number, which can be used to track the dispute. Sara will be discussing Mental Health Awareness Month and cultural competency. Explore Out-of-Network Coverage for more information about your network. Your plan does not encourage doctors to give less care than you need. % External link You are leaving this website/app (site). Some benefit plans administered by BCBSIL, such as some self-funded employer plans or governmental plans, may not utilize BCBSIL Medical Policies. MMAI and BCCHP Providers: Join Our Community Stakeholder Committee End along the Ruhr meadows over Lake Kemader to Lake Baldeney in Essen. Blue Cross and Blue Shield of Illinois is proud to be the states only statewide, customer-owned health insurer. Prior authorization requests for administrative days (ADs) may not be submitted online at this time. If you want to know more about the utilization management process or how decisions are made about your care, Contact Us. The ASAM Criteria, 2021 American Society of Addiction Medicine. Most PDF readers are a free download. Prior Authorization Support Materials (Government Programs) - BCBSIL Create an account. This link will take you to a new site not affiliated with BCBSIL. MMAI Medical Benefits | Blue Cross and Blue Shield of Illinois - BCBSIL Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. 396 0 obj <>/Filter/FlateDecode/ID[<0A7FBF13C253BF478050EB5B54DA8A47><3D37E1700F053247902B206B607ACED5>]/Index[373 43]/Info 372 0 R/Length 112/Prev 171011/Root 374 0 R/Size 416/Type/XRef/W[1 3 1]>>stream Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. These tools used by PCPs (or specialists) include medical codes. 1 0 obj Step-by-Step Guide for Provider Finder. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). The most popular and difficult historic site trail in Wetter is Von Wetter zum Nacken with a 3.6-star rating from 2 reviews. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider. During weekend hours, UM reviewers and medical directors continue to review requests and make decisions. Search your plan's drug list, find a pharmacy, and more. Where: Hybrid, Join us in person: endobj See below for details, including the Zoom registration link. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. External link You are leaving this website/app (site). Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. You may be familiar with some of the Medicaid prior authorization resources on our Provider website. April 24, 2023. You can: Pay a bill online or sign up for auto bill pay. Which historic site trail has the most elevation gain in Wetter? Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. One The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. This approval is called "prior authorization." 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. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM - BCBSIL At every meeting, we share updates for MMAI and BCCHP providers, such as new programs and resources to share with your patients. Your doctors will use other tools to check prior authorization needs. A provider may initiate a peer-to-peer discussion by calling 800-981-2795. Refer to our Medicaid prior authorization summary for more details. eviCore healthcare (eviCore) is an independent company that has contracted with Blue Cross and Blue Shield of Illinois to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. We are also the largest provider of health benefits in Illinois, serving more than 8.9 million members in all 102 counties across the state. Welcome. You are leaving this website/app ("site"). MMAI Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. Click here to see prior authorization tools, clinical review criteria and MMAI Medical Policies used by your doctor to make a decision. Clear and timely submission of prior authorization requests and clinical documentation is very important to process requests within the required timeframes. As of this date, providers may submit a new packet for clinical re-review OR do a peer-to-peer discussion. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Our doctors and staff make decisions about your care based only on need and benefits. Explore the most popular historic site trails near Wetter with hand-curated trail maps and driving directions as well as detailed reviews and photos from hikers, campers and nature lovers like you. Our trusted community experts can give you the one-on-one help you need to shop for health insurance. BCBSIL adheres to the standards for addressing all urgent concurrent requests, meeting or exceeding National Committee for Quality Assurance (NCQA) standards. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM Always check eligibility and benefits first through Availity or your preferred web vendor portal to confirm coverage and other important details, including prior authorization requirements and vendors, if applicable. All Rights Reserved. It will open in a new window. k+:6@1)^]WNQj sGG& hFa`@,%LFPBA7Xmxt$.=e0ne}#IoE 20iF 6Xg8Sf;+-P > Additional clinical information will not be reviewed by the utilization management team if the initial determination was an adverse determination due to failure to submit clinical information with the original request. To see if you are eligible, Contact:Blue Cross and Blue Shield of Illinois' OTC vendor,Convey Health Solutions, at: 1-855-891-5274. The tool returns a list of services that may require prior authorization through BCBSIL or eviCore healthcare (eviCore) for BCCHP and MMAI members. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. For some services/members, prior authorization may be required through BCBSIL. The site may also contain non-Medicare related information. Prior Authorization Support Materials (Government Programs) - BCBSIL 3 0 obj hb``0b`0 36 fah@t#(f`XU1U B)xPB2@+4s\ X:EolHd]1ofxF/120i7@ZN 4`SBa@3P]8D5/@ F& endstream endobj 13 0 obj <>]/Pages 10 0 R/Perms/Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/Type/Catalog/ViewerPreferences<>>> endobj 14 0 obj <. If we do not receive adequate clinical documentation, BCBSIL will reach out to your facility UM department and provide a date and time in which clinical documentation is required to be received. Out-of-Network Coverage. These tools used by PCPs (or specialists) include medical codes. Simply enter a 5-digit code, service description or drug name in the search field. Medicaid | Blue Cross and Blue Shield of Illinois - BCBSIL For some services/members, prior authorization may be required through BCBSIL. File is in portable document format (PDF). Use Our New Prior Authorization Digital Lookup Tool for Medicaid Member There are no rewards to deny or promote care. Davis Vision is an independent company that has contracted with BCBSIL to provide vision benefits administration for government programs members with coverage through BCBSIL. Most PDF readers are a free download. This step also helps you identify prior authorization requirements and utilization management vendors, if applicable. In addition, some sites may require you to agree to their terms of use and privacy policy. If no clinical information was submitted with a request, a peer-to-peer discussion is not permitted. What is the longest historic site trail in Wetter? Wetter: With an ascent of 703 m, WestfalenWanderWeg Etappe 3: Wetter - Schwerte has the most elevation gain of all of the historic site trails in the area. Your doctors will use other tools to check prior authorization needs. Who is responsible for getting the prior authorization? eviCore healthcare (eviCore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. Frequently asked questions about historic site trails in Wetter. Talk with your doctor about your medication. To view this file, you may need to install a PDF reader program. Legal and Privacy The peer-to-peer discussion is available as a courtesy to providers. option is Adobe Reader which has a built-in reader. Stage 3 of the long-distance hiking trail WestfalenWanderWeg, North Rhine-Westphalia. If you have any questions, call the number on the members ID card. Whens the meeting for the next quarter? Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL In addition, some sites may require you to agree to their terms of use and privacy policy. References to other third party sources or organizations are not a representation, warranty or endorsement of such organizations. DentaQuest is an independent company that provides dental benefits for BCBSILs Medicaid plans. How Does Blue Cross Community MMAI (Medicare-Medicaid Plan)SMMake Decisions for Prior Authorizations? Medicaid Providers: Updated Prior Authorization Tips and Peer-to-Peer PDF Medicaid Prior Authorization Request Form - BCBSIL Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the conditions of the patient in determining the appropriate course of treatment. Sometimes you may need to get approval from Blue Cross and Blue Shield of Illinois (BCBSIL) before we will cover certain inpatient, outpatient and home health care services and prescription drugs. You can find out if your drug has any added conditions or limits by looking at the Drug List. Well also include reminders in the Blue Review. (Accessible to providers through the BCBSIL-branded Payer Spaces section in, 2022 MA PPO and MA HMO Non-Delegated Prior Authorization Requirements Summary, 2022 MA PPO and MA HMO Non-Delegated Prior Authorization Code List, 2022 Medicaid Prior Authorization Requirements Summary, 2022 Medicaid Prior Authorization Code List, American Society of Addiction Medicine (ASAM), Illinois Department of Human Services/Division of Mental Health, Illinois Department of Health and Family Services Medicaid Provider Handbooks, Utilization Management Process Overview (Gov Programs), Blue Cross Medicare Advantage HMO Non-Delegated Model, Blue Cross Community MMAI (Medicare-Medicaid Plan). Copyright document.write(new Date().getFullYear()); Health Care Service Corporation. Your doctor should know which services need approval and can help with the details. Failing to provide clinical information or timely notification of prior authorization requests may affect the outcome of a Service Authorization Dispute. Qf#yQ>u(KpRE{UIQp[)5T:p:jBFp*WWhwIA36YwNG)!G/!Yr6v7e|12 rUp3?R1H-6Kre vh) yj?O&y]\x,$aU7Mm'a 5a1owahiT@IC+ The site may also contain non-Medicare related information. From Essen-Kupferdreh back with the S-Bahn to the main station and from there without changing with the RE 16 back to Siegerland. One option is Adobe Reader which has a built-in reader. To return to our website, simply close the new window. Luckily, your health insurance can change with you. @SssUJ- =`~4*>_faS A$wa8|9NN4 d>!XHDhf\~%r'7m|oHF~D#R X(b(uQu (pd)8MA/> ?&ME.@.$O4>!Mwiw%c:IlAc:4U&SUDaE:?{Or-RaX%,(( If you have any questions, call the number on the member's BCBSIL ID card. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. You can get one shipment every three months. The digital lookup tool is intended for reference purposes only. Home and Community-Based Services & Waivers, Grievances, Appeals and Coverage Decisions, Language Assistance and Non-Discrimination Notice. File is in portable document format (PDF). Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. All Rights Reserved. endstream endobj 374 0 obj <. One option is Adobe Reader which has a built-in reader. New to Blue Access for Members? Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. If an appeal has been filed, the peer-to-peer discussion is no longer available. When faxing prior authorization requests, you must use the Medicaid Prior Authorization Request Form.