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We’ll Begin Removing Recommended Clinical Review as an Optional Medical Necessity Review, Effective Jan. 1, 2027
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 17, 2026
Summary
Blue Cross Blue Shield of Illinois will eliminate 'recommended clinical review' as an optional medical necessity review process for commercial members, effective January 1, 2027. Services that previously qualified for recommended clinical review will now require prior authorization instead. Billing teams must verify eligibility and prior authorization requirements through Availity Essentials before rendering services.
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What to do
by Dec 31, 2026 · 7 steps
01Billing team must update workflows to eliminate reliance on 'recommended clinical review' for commercial BCBS IL members.
02Effective January 1, 2027, all services previously submitted for recommended clinical review must now be routed through prior authorization processes.
03Update billing software, encounter forms, and provider communication templates to reflect this change.
04Verify eligibility and prior authorization requirements through Availity Essentials before any service delivery.
05Train front desk, clinical, and billing staff that recommended clinical review is no longer an option for commercial members throughout 2027.
06Failure to obtain required prior authorization will result in claim denials.
07Note: This change does not affect Medicare Advantage or Medicaid members, who already do not have this review option available.
Original notice
We’ll Begin Removing Recommended Clinical Review as an Optional Medical Necessity Review, Effective Jan. 1, 2027
bcbsil.com · Always check the source before changing claims.