iexchange Prior Authorization Process for Healthcare Providers

To initiate the prior authorization process, healthcare providers can submit requests online through the iexchange portal, which is available 24/7. This electronic submission process allows for faster processing and reduces paperwork.

Healthcare providers can also submit requests via fax or mail, but these methods may take longer to process. The iexchange team reviews each request carefully to ensure accuracy and completeness.

Once the request is submitted, the iexchange team will review it and contact the healthcare provider if additional information is needed. This ensures that the prior authorization process is completed efficiently and accurately.

iexchange aims to process 95% of prior authorization requests within 2 business days, making it an efficient solution for healthcare providers.

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Submitting a request through iExchange is a straightforward process. You can access iExchange 24 hours a day, 7 days a week.

To get started, you'll need to register with Availity, which is free. You can sign up on the Availity website or through the BCBSIL Provider website. If you're already a registered Availity user, you can enroll to use iExchange through the Payer Spaces – select the Resource tab, then “Pre Auth Registration.”

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Once you're registered, you can submit benefit preauthorization requests online through iExchange. This includes requests for intensive outpatient program (IOP) and electroconvulsive therapy (ECT) services for BCBSIL members with commercial and on/off-exchange health plans.

To submit a request, follow these steps:

You can also use the online benefit preauthorization tool to check eligibility and benefits for each patient. This will help you identify benefit preauthorization requirements and specify utilization management vendors that must be used, if applicable.

Remember, checking eligibility or benefits, or the fact that a service has been preauthorized, 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 applicable on the date services were rendered.

If you need further assistance or customized training, contact BCBSIL’s Provider Education Consultants at [email protected].

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To initiate the prior authorization process, you'll need to submit your requests using the specified forms.

If you're submitting a commercial prior authorization request, you can fax the required forms to complete the process.

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Benefit preauthorization is a crucial step in the healthcare process, and iExchange makes it easier than ever to submit requests online. iExchange is available 24/7 and can be accessed by physicians, professional providers, and facilities who have obtained a provider record with BCBSIL.

To use iExchange, providers can submit benefit preauthorization requests for IOP and ECT services for BCBSIL members with commercial and on/off-exchange health plans. This online tool is accessible through the Availity Portal or your preferred vendor portal.

It's essential to note that checking eligibility and benefits first will help identify benefit preauthorization requirements and specify utilization management vendors that must be used, if applicable. Providers can submit online eligibility and benefits requests via the Availity Portal or their preferred web vendor portal.

Here are the steps to obtain benefit preauthorization through BCBSIL for inpatient services:

Remember, requesting benefit preauthorization is not a substitute for checking eligibility and benefits. It's critical to verify eligibility and benefits prior to rendering services to determine if benefit preauthorization is required.

As a provider, it's essential to understand your responsibilities when it comes to prior authorization through iExchange. Participating providers are responsible for obtaining applicable benefit preauthorization as required prior to rendering inpatient services for Blue Cross and Blue Shield of Illinois (BCBSIL) members.

You can obtain benefit preauthorization through iExchange, an online tool accessible to physicians, professional providers, and facilities contracted with BCBSIL. To set up a new account, refer to the iExchange page in the Provider Tools section of the Provider website.

If you're unable to obtain preauthorization online, you can submit an electronic transaction through Availity or your preferred vendor portal. Alternatively, you can call the number on the member's BCBSIL ID card or the BCBSIL Provider Telecommunications Center (PTC) at 800-972-8088 for assistance.

It's crucial to note that services performed without first obtaining applicable benefit preauthorization may be denied in whole or in part for payment. This means you won't be able to seek reimbursement from the member, so it's essential to request preauthorization before providing services.

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Here are the three ways to obtain benefit preauthorization:

Remember, requesting benefit preauthorization is not a substitute for checking eligibility and benefits. You should always verify a member's eligibility and benefits before providing services.