July 7, 2025
As we announced previously, effective Aug. 1, 2025, Carelon Medical Benefits Management will replace EviCore healthcare for some prior authorization requests for our members with Blue Cross Community Health PlansSM.
When and how to contact Carelon: Carelon will begin processing requests as of July 14, 2025. You may contact Carelon beginning July 14 for prior authorization requests for dates of service on or after Aug. 1.
- Online – The Carelon provider portal is available 24/7
- Phone – Call Carelon at 866-455-8415, Monday through Friday, 7 a.m. to 7 p.m. CT
Affected care categories: This transition includes prior authorization requests for members with BCCHPSM for some services in the following care categories:
- Genetic testing
- Medical oncology
- Radiation oncology
- Musculoskeletal (spine, joint and pain procedures)
- Radiology
- Rehabilitation (physical, occupational and speech therapy)
For a list of codes for services in each category where prior authorization is required for BCCHP, see prior authorization support materials (government programs).
For more information on the transition, view details and important reminders. To learn more about Carelon, register for a live training session. On-demand training sessions also are available on the Carelon portal.
Obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.
Carelon Medical Benefits Management (formerly AIM Specialty Health) is an independent company that has contracted with Blue Cross and Blue Shield of Illinois to provide utilization management services for members with coverage through BCBSIL. EviCore healthcare is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.