Oct. 1, 2024
As part of our review to determine medical necessity, we use clinical criteria from the American Society of Addiction Medicine’s Treatment for Addictive, Substance-Related, Co-Occurring Conditions.
On Jan. 1, 2025, Blue Cross and Blue Shield of Illinois will refer to ASAM’s new Criteria 4.0 in our medical necessity reviews of services rendered to adults. ASAM Criteria 3.0 will continue to apply in our medical necessity reviews of services rendered to adolescents.
If you have further questions, please call the member services number on the member’s benefit card.
Learn more about ASAM’s Treatment for Addictive, Substance-Related, Co-Occurring Conditions.
The American Society of Addiction Medicine is an independent company that has contracted with Blue Cross and Blue Shield of Illinois to provide utilization management support for members with coverage through BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.
This is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.