BCBS Illinois Predetermination Form Guide and Tutorial

The BCBS Illinois predetermination form is a crucial tool for medical providers and patients alike. It's a request for prior authorization that helps determine if a treatment or service is covered by BCBS Illinois.

To start the process, you'll need to download and complete the BCBS Illinois predetermination form, which is available on their website. The form typically requires detailed information about the patient, the proposed treatment, and the expected outcomes.

The form should be submitted to BCBS Illinois at least 5 business days before the scheduled treatment date to ensure timely review. This allows the insurance company to review the request and make a decision before the treatment occurs.

A completed predetermination form can help prevent delays in treatment and ensure that patients receive the care they need in a timely manner.

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Completing the Form requires a thorough understanding of the recommended clinical review process. This process typically involves a comprehensive evaluation of the patient's medical history and current condition.

The recommended clinical review may include an assessment of the patient's medications and potential interactions with the treatment being proposed. This is crucial to ensure patient safety.

A clinical review may also involve evaluating the patient's medical history for any conditions that may contraindicate the treatment. This includes reviewing the patient's history of allergies and sensitivities.

The clinician will also consider the patient's current health status, including any comorbidities or chronic conditions. This information is essential to determine the best course of treatment.

A thorough clinical review can take anywhere from 30 minutes to several hours, depending on the complexity of the case.

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You can forget about scanning and printing out forms, as you can fill out and eSign your documents online.

BCBS offers a quick guide on how to complete the predetermination form, which makes the process much easier.

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You can complete the form online, which is a much faster and more convenient option.

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To get started with the predetermination process, you'll need to fill out a form that's specifically designed for this purpose. This form is available for faxing or mailing, and it's essential to include all required information to ensure a smooth review process.

The form requires you to provide the member's identification number, which should include the alpha prefix. You'll also need to include the group number, patient's first and last name, and the member's first and last name.

To facilitate your review, you'll need to attach any relevant documentation, such as the place of treatment, evaluation or health history, office or therapy notes, CPT procedure codes, and ICD9 diagnosis codes. Be sure to check all applicable boxes to ensure your documentation is complete.

If you're faxing the form, please note that only the dedicated fax number (800) 852-1360 will be accepted. If you're mailing the form, you can send it to Blue Cross and Blue Shield of Illinois at P.O. Box 805107, Chicago, IL 60680-4112.

Here's a summary of the required information:

Remember to carefully review the form and ensure all required information is included before submitting it. If you have any questions or concerns, don't hesitate to reach out for assistance.