Q: What is changing Jan. 1, 2026?
A: Effective Jan. 1, 2026, Alacura Medical Transportation Management will conduct prior authorization, recommended clinical review and retrospective claim review for fully insured and retail non-HMO air and ground medical transportation claims. Call Alacura at 866-671-5085 before nonemergency and nonurgent transports. Alacura may review urgent and 911 claims after the fact.
Q: Who is Alacura?
A: Alacura Medical Transportation Management, LLC, provides utilization management services.
Q: What does Alacura do for BCBSIL?
A: Alacura conducts prior authorization, recommended clinical reviews and retrospective claim reviews of air and ground medical transportation claims based on our medical policy for ambulance and transport services (policy ADM1001.005).
Q: What services does Alacura review?
A: The following table shows the services and type of review Alacura conducts for each. Please check Availity Essentials to ensure the service requires prior authorization or recommended clinical review.
|
| Transport service |
Prior authorization, (contact Alacura before transport) |
Optional recommended clinical review (recommended, but not required, to contact Alacura before transport) |
Post-service review
(submit clinical documentation to Alacura) |
| Urgent, emergent, and 911 scene ground and air |
|
|
 |
| Applicable nonurgent ground and air (check Availity Essentials) |
|
|
|
Q: How should providers contact Alacura?
A: Alacura offers several methods for providers to request prior authorization, seek recommended clinical review, or submit information for post-service medical necessity reviews:
For faster service, providers can call Alacura to speak to a nurse. The dedicated line for BCBSIL is 866-671-5085 and is answered by a person 24/7/365.
Q: What about Blue Cross and Blue Shield patients who have home plans in another state?
A: For members with Blue Cross and Blue Shield plans other than BCBSIL, follow the prior authorization requirements of the plan on the member ID card. Refer to information on BlueCard® claims.
Q: When should hospitals call Alacura before the ambulance provider?
A: Hospitals should call Alacura first for prior authorization of:
- All facility-to-facility transports when immediate transport is not required to prevent harm to the patient, even when the patient is in the emergency department. Alacura can assist with scheduling transport once transportation has been approved.
- All nonemergent outpatient transports and facility-to-home or facility to a lower level of care.
Q: When is it not necessary for providers to contact Alacura before transport?
A: Urgent, emergent, 911 residence, or 911 scene-based transports do not require prior authorization. These claims may be subject to post-service medical necessity reviews by Alacura.
Q: What information should the provider have ready to submit to Alacura for prior authorization or when seeking recommended clinical review?
A: Provide the following information when requesting prior authorization or seeking recommended clinical review from Alacura:
- Patient name, date of birth and subscriber ID
- Face sheet, if the member is in a facility
- Clinical records
- Patient destination and reason for transport (example: necessary specialty services are not available at the current facility), and details about the selection of the facility if it is not the closest with the needed services.
- Date when transport is desired
Q: What happens when a provider calls Alacura for prior authorization before transport?
A: Alacura will conduct a verbal review of the patient’s clinical status. If the transport is determined to be not medically necessary, the provider will have the opportunity for a peer-to-peer. If still denied, a written determination with appeal instructions will be issued.
Q: If a member needing transport is hospitalized, will Alacura select the primary ambulance provider currently serving the hospital?
A: Yes, if the hospital’s primary ambulance provider is in-network with BCBSIL, Alacura will work with the ambulance provider. If the ambulance provider is out-of-network, Alacura will attempt to find an appropriate in-network ambulance service available within the needed time frame. If no in-network provider is available, an out of network provider can be used.
Q: Where do providers submit claims for ambulance services subject to review by Alacura?
A: Submit claims to BCBSIL following normal claims submission processes. To decrease delays in processing, review and reimbursement include:
- Ambulance run report
- Flight records
- Any clinical documentation from the requesting facility
If claims are submitted without clinical documentation, BCBSIL will send the submitting provider a letter and explanation of benefits with instructions on how to submit records for review. Providers can submit records to BCBSIL, who will forward to Alacura, or to Alacura directly.
Q: What if a provider disagrees with Alacura’s decision regarding their transport claim?
A: If prior authorization is denied, the provider can request a peer-to-peer while on the phone. If still denied, or if the claim is denied after a post-service medical necessity review, the provider can appeal the decision. Instructions for appeal will be included in the denial letter.
