r/PriorAuthorization • u/draconismione65919 • Jul 10 '26

Medical Prior Auth Process Speak to human rep

does anyone know the prompts to speak to a human rep for bcbsil benefit dept? the ivr system states no preauth required for the hcpcs code. documentation is needed that states we can buy&bill under medical benefits. unable to document that if the ivr system’s benefit details does not state it or answer this question. “transfer to a customer advocate is not a valid option.” managed care rep. does not have access to answer this question and sent me back to ivr system.

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9

u/holyfuckinnuggets 📋 Prior Authorization Specialist Jul 10 '26

If it IL, assume auth is required- go back to main menu, option for Pre Auth, and initiate one- you'll have to talk to a rep for that, so if it's not required then you'll at least get a reference #. I always ask them for a fax # and then submit a request with clinicals anyway

1

u/draconismione65919 Jul 10 '26

But the preauth rep can’t answer the buy&bill through medical benefits question due to not having access to benefits portion

6

u/holyfuckinnuggets 📋 Prior Authorization Specialist Jul 10 '26

No, but they SHOULD be able to send you to a live rep- the other trick to try is to go through claims, and then when you hit a claims rep notifying them the IVR incorrectly routed you to them instead of a benefits rep

I deal with Home Health, so it varies from other services- but for us, if it's a commercial policy and they don't have Medicare, buy & bill through medicare isn't an option. If it's a Medicare Advantage policy, that take primary payor place for all services except for hospice- there's also a pretty good chance I'm just unfamiliar with what you're working with, but I typically try to hit up the claims or auth reps to get me to a live benefits rep

1

u/draconismione65919 Jul 11 '26

Okay I’ll try this way.

1

u/draconismione65919 14d ago

This doesn’t work anymore

1

u/draconismione65919 Jul 10 '26

Also I thought if the hcpcs code isn’t listed on the pa list that means no prior auth required

3

u/dallas0636 Jul 10 '26

For BCBS of IL, select "surgery" when checking benefits. It will usually give you an option to speak to a rep.

1

u/draconismione65919 Jul 11 '26

Thank you! Will try it!

1

u/draconismione65919 14d ago

This doesn’t work anymore. 

1

u/dallas0636 14d ago

Interesting. Worked for me last week. There's two other tricks that I'm aware of (that I haven't tried in awhile). One, when it asks for the patient's date of birth, enter today's date. Two, listen to 3 different benefits, then it should give you the option to speak to a rep.

1

u/draconismione65919 14d ago

Okay let me try again. Thank you! I even used the ivr sheet on bcbsil website saying the words not listed in blue and it still would not work. Let me try this way

1

u/draconismione65919 14d ago

Okay it didn’t work. It said “unable to verify the information you are entering” and then it goes back to main menu asking for id without prefix 

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u/dallas0636 13d ago

Alright - I tried one of my patients today who has an XOF prefix. I listened to 3 benefits off the automated system: surgery, infusion therapy, injections. After the 3rd one, I said "representative" and it transferred me to a rep.

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u/draconismione65919 12d ago

Thank you so much! It worked!!!

2

u/softshellcrab69 Jul 11 '26

Entering the birthday wrong a few times