2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals Note: The calendar year deductible applies to almost all benefits in this Section. We say '(No deductible)' when it does not apply.
Blue Care Network contracts with eviCore healthcare® to provide utilization management for the following services:
- Outpatient physical, occupational and speech therapy services for BCN HMOSM (commercial) and BCN AdvantageSM members delivered by independent physical therapists, outpatient therapy providers, physician practices and hospital-based outpatient therapy services
- Physical medicine services provided for BCN HMO members by chiropractors (starting May 27, 2019) and by athletic trainers (for dates of service on or after Jan. 1, 2021)
- Blue Cross Blue Shield: June 15, 2020 ('All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in.
- What is my copay for therapy with Blue Cross Blue Shield of Illinois? Blue Cross Blue Shield Illinois plans have copays averaging $15 - $50 per session for in-network therapy appointments (as stated above). That said, the amount of your copay depends on the details of your specific plan.
Blue Cross Blue Shield Therapy Finder
Authorization requests for both initial and follow-up visits should be submitted to eviCore in one of these ways:
Blue Cross Blue Shield Physical Therapy Copay Cards
- By clicking the Authorizations and Referrals button for the member on the web-DENIS Eligibility/Coverage screen
- Through the eviCore healthcare provider portal at www.evicore.com*
- By calling eviCore at 1-855-774-1317, preferably prior to providing services
For additional information on the utilization management requirements for these services, refer to the Utilization Management chapter of the BCN Provider Manual. Look in the section titled 'Managing PT, OT and ST / Managing physical medicine services.'
Blue Cross Blue Shield Therapists
These utilization management requirements don’t apply to BCN 65 members or to the treatment of autism spectrum disorders for members 18 years of age and younger.
Resources for managing therapy and physical medicine services
- Outpatient rehabilitation services: Frequently asked questions (PDF)
- BCN implementation page on the eviCore website*
- Understanding your BCN coverage for different therapy / physical medicine services (PDF)
- Tips about eviCore Authorizations for BCN Members (PDF)
- Suggestions for the Efficient Utilization of Therapy and Physical Medicine Services (PDF)
- Tips for improving treatment efficiency (PDF)
- FAQs: Practitioner Performance Summary and Provider Categories* (PDF)
- Chiropractic services: For chiropractic manipulations and physical medicine services by chiropractors (PDF) - Includes information about utilization management programs
- U-M Premier Care Primary (Major) Diagnosis Codes for Therapies (PDF)
See also BCN's eviCore-Managed Procedures page on this website.
Blue Shield Physical Therapy
*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.