Social Work News

Thursday, December 9

BlueCross BlueShield of Illinois Pre-Certification Procedures

Joel L. Rubin, MSW, CAE

BlueCross BlueShield of Illinois Pre-Certification Procedures: Implications for Social Workers

Late last year we reported to the membership that BlueCross BlueShield of Illinois (BCBSIL) decided to rescind its pre-certification requirement for 2010.

Many social workers and other mental health professionals in Illinois have been notified that beginning January 1, 2011, they will be required to request preauthorization for all covered behavioral services.

There are many concerns about this new requirement including:

  • A possible violation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 that became law in October of 2008;
  • Whether the pre-authorization will be burdensome to care and limit access to service, thereby again violating the MHPAEA of 2008; and
  • The unclear nature of the required Outpatient Treatment Request (OTR) form to evaluate if the requested services are medically necessary.

If you are a BCBSIL provider, here are some action steps for you to undertake:

  • Contact your BCBSIL Network Consultant regarding these concerns;
  • Advise your clients to call BCBSIL as well as their employers;
  • Let NASW Illinois know whether or not your clients experience any limited access to care due to the new pre-certification requirement.

The NASW Illinois Chapter has notified the Illinois Department of Insurance and is currently scheduling a meeting with them. We are also working with other allied mental health professional associations on this issue.

Posted on 12/09/10 at 10:06 AM


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