You are leaving this website/app ("site"). Updated Provider Dispute Process Overview for Government Programs - BCBSIL BCBSIL makes no endorsement, representations or warranties regarding third-party vendors. Renew Illinois Individual, Family & Medicaid Health Insurance, Blue Cross Community MMAI (Medicare-Medicaid Plan), Illinois Health Plan Tiered Prescription Drug Lists, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. To ask for instructions on how to appeal, call the Member Services line for the MMAI plan or call the Senior HelpLine and ask for the MMAI Ombudsman at 1-800-252-8966 (TTY users should call 1-888-206-1327) Monday-Friday 8:30 am-5pm. 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. 101 S. River Street Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Failing to provide clinical information or timely notification of prior authorization requests may affect the outcome of a Service Authorization Dispute. As you transition to Medicare, we hope you'll Stay with Blue and get Medicare coverage from a company you trust. Medicaid Providers: Updated Prior Authorization Tips and Peer-to-Peer April 24, 2023. In addition, some sites may require you to agree to their terms of use and privacy policy. Medical Benefits Blue Cross Community MMAI (Medicare-Medicaid Plan) SM covers many of your health care needs. Well also include reminders in the Blue Review. Register Now. Blue Cross Community MMAI (Medicare-Medicaid Plan) SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. Life changes happen at any time. PDF Post-Acute Care Utilization Management Program for Blue Cross and Blue The site may also contain non-Medicare related information. The site may also contain non-Medicare related information. x=r8?Qi xJI&JfIl3D:#SfAw $nb"n q~+|Vz?p~Q{vrle{{_F^gEx6,>/?e=kOws/nTgO~S>)ga0)D>Mx,lN}=v,QPD>j" Our doctors and staff make decisions about your care based on need and benefits. How do I know if I need a prior authorization? eviCore healthcare manages all Inpatient Post-Acute Care (PAC) preauthorization requests for Blue Cross and Blue Shield of Illinois (BCBSIL) members enrolled in the following programs: Medicare Blue Cross Medicare Advantage (PPO)SM Medicaid Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Non-Discrimination Notice. 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. Topics include everything from improving your well-being to explaining health coverage. Click here to see prior authorization tools, clinical review criteria and MMAI Medical Policies used by your doctor to make a decision. Out of area dialysis services. These tools used by PCPs (or specialists) include medical codes. Sign up! Medicaid | Blue Cross and Blue Shield of Illinois - BCBSIL This new site may be offered by a vendor or an independent third party. File is in portable document format (PDF). Blue Cross Community MMAI (Medicare-Medicaid Plan) SM - BCBSIL They use what is called clinical criteria to make sure you get the health care you need. When: Thursday, May 18, 2023, from 1 to 2:30 p.m. CST This list includes generic and brand drugs and medical supplies. Welcome. MMAI Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL The Customer Service representative will provide you a reference number, which can be used to track the dispute. 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. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes: Medical benefits such as coverage for preventive care services, emergency and urgent care coverage, diagnostic tests and more Behavioral Health benefits Prescription coverage Transportation Services to help you get to and from your appointments Dental care, eye care, and more