BlueApprovR is an online tool accessible in Availity® Essentials that allows providers to submit inpatient and/or outpatient prior authorization and recommended clinical review requests for medical and surgical, specialty pharmacy drugs, and behavioral health services for many commercial non-HMO members.
BlueApprovR is designed to help simplify the provider submission process by asking for the information to support a medical necessity determination.
Note: Your RCR submissions will follow the same path through BlueApprovR as prior authorization requests.
You can find a list of services for which recommended clinical review is available on our Recommended Clinical Review (Predetermination) Code List.
Registered Availity Essentials users have free, 24/7 access to BlueApprovR tool to:
- Secure real-time approvals for certain services and begin treatment right away
- Easily attach medical records
- Check approval status
Use BlueApprovR to request prior authorization and recommended clinical review for these types of care:
- Specialty Pharmacy Drugs
- Behavioral Health
- Inpatient Acute Care
- Long-term Acute Care
- Inpatient Rehab
- Skilled Nursing Facility
- Outpatient Hospice
- Inpatient Hospice
- Home Health
- Outpatient Service
How to Access BlueApprovR:
- Log in to Availity Essentials
- Select Payer Spaces from the navigation menu and choose BCBSIL
- Within Payer Spaces, select the Applications tab and click BlueApprovR
- Users will be redirected to BlueApprovR to complete the request online
Resources and Support:
- See our quick overview on the value of using BlueApprovR
- Refer to the BlueApprovR User Guide to learn how to access and use BlueApprovR via Availity Essentials.
- The BlueApprovR Behavioral Health User Guide assists with requesting initial behavioral health prior authorization requests, concurrent review, revision of the end date, and patient discharge instructions.
- For education, training, and technical assistance with this tool, contact the BlueApprovR Support Team.
Note: This tool is currently not available for Medicare Advantage, Illinois Medicaid members, or Federal Employee Program®. Please use your existing process for requesting prior authorization for these members.
Checking eligibility and/or benefit information, obtaining prior authorization or the fact that a recommended clinical review (predetermination) decision has been issued 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Regardless of any prior authorization or recommended clinical review (predetermination), the final decision regarding any treatment or service is between the patient and the health care provider. If you have any questions, call the number on the member's ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.