Blue Cross Blue Shield of Illinois - Medicaid/Medicare Plans Provider Resources
EviCore by Evernorth is an independent company that provides preauthorization for selected care categories for Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas. Please select your state below to access additional program details for Commercial, Medicare, and/or Medicaid membership. Services performed without a preauthorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
Medical Oncology CPT codes no longer require pre-authorization through EviCore as of 1/1/2024. Please refer to the Provider News/Updates notice at BCBSIL.com for a list of codes that require authorization through BCBSIL as of 1/1/2024. If you have any questions, please contact BCBSIL using the number on the back of the member’s ID card.
Radiation Oncology CPT codes no longer require pre-authorization through EviCore as of 1/1/2024. Please refer to the Provider News/Updates notice at BCBSIL.com for a list of codes that require authorization through BCBSIL as of 1/1/2024. If you have any questions, please contact BCBSIL using the number on the back of the member’s ID card.
EviCore by Evernorth is an independent company that provides preauthorization for selected care categories for Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas. Please select your state below to access additional program details for Commercial, Medicare, and/or Medicaid membership. Services performed without a preauthorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
EviCore is an independent company that provides preauthorization for selected care categories for Blue Cross and Blue Shield of Illinois. Please select your state below to access additional program details for Commercial, Medicare, and/or Medicaid membership. Services performed without a preauthorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
Medicare Membership:
Blue Cross Medicare Advantage (PPO) SM
Blue Cross Community MMAI (Medicare-Medicaid Plan) SM
Blue Cross Medicare Advantage HMO
Illinois Individual Medicare HMO
Illinois Group Medicare PPO
Medicaid Membership:
Blue Cross Community Health PlansSM” (BCCHP)
Providers should contact EviCore to obtain Pre-Certifications for services listed below. Services performed without a pre-authorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
Obtain Authorization for:
Ultrasounds do not require pre-authorization as of 7/1/2023. Should you have any questions, please contact BCBSIL using the number on the back of the member's ID card. Please see the code lists located at evicore.com for codes managed by EviCore.
BCBS IL Medicaid: Effective 9/1/2019, Cardiovascular services are no longer in scope for management by EviCore. Please see the code lists located at evicore.com for codes managed by EviCore.
BCBSIL Medicare: Effective 9/1/2019, ST, OT, PT, Chiropractic, and Cardiovascular services are no longer in scope for management by EviCore. Please see the code lists located at evicore.com for codes managed by EviCore.
Lab Management Solutions-Molecular and Genomic Lab Testing
Musculoskeletal Services
Joint Surgery (Outpatient/Inpatient)
Spine Surgery (Outpatient/Inpatient)
Interventional Pain (Outpatient)
Outpatient Advanced Radiology Imaging
Outpatient Sleep
Outpatient Specialty Drug
Post-Acute Care (Outpatient/Inpatient)
POST-ACUTE CARE PROVIDER CAPABILITY SURVEY
Our Provider Survey is designed to receive information about your facility to better understand the services you offer as well as your operations and clinical capabilities. Please click here to participate in our brief survey.
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Laboratory Management
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Medical Drug Management
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Medical Specialty Drugs
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Musculoskeletal
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Post-Acute Care
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Radiology
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Sleep
Laboratory Management
Musculoskeletal
Radiology
Sleep
Post-Acute Care
Medical Drug Management
Medical Specialty Drugs
Need Help?
Registration Instructions
EviCore highly recommends providers take full advantage of the online capabilities at https://www.evicore.com/provider
Here you can request prior authorization, review our nationally accepted evidence-based guidelines, and receive announcements about program updates. Access requires only your email address and a brief registration.