Fill out a transition of care form. Some services require approval from Blue Cross and Blue Shield of New Mexico (BCBSNM). top: 6px; What is Prior Authorization. Because you are still responsible for ensuring that your care is precertified, you should always ask your provider if they have contacted us and provided all the necessary information. Services, Durable Medical Equipment (DME) and Prostheses requiring Prior Authorization Types of utilization management review that may be conducted before services are rendered include prior authorization, predetermination and pre-notification. All rights reserved. To find out if you qualify for transition of care, BCBSTX may need to request medical information from your current provider(s). span.purple { ©1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Please refer to AHIN, Arkansas Blue Cross Coverage Policy or the member’s benefit certificate to determine which services need prior approval. For the convenience of our providers, Blue Cross and Blue Shield of Oklahoma providers may submit preauthorization requests via Availity Authorizations & Referrals, a Web-based automated tool. margin: 0 0 1em 0; In general, your network PCP and other network providers are responsible for obtaining prior authorization before they provide these services to you. This is called transition of care. eviCore healthcare helps to ensure our members receive appropriate radiology/imaging services, provides clinical consultation to our participating healthcare professionals and assists in the … You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Prior authorization. To use their website/app, you may need to agree to their terms of use and privacy. Monday – Friday 8 a.m. – 5 p.m. CT, . CORONAVIRUS UPDATE: FEP will waive prior authorizations for medically necessary diagnostic tests and covered services that are consistent with CDC guidance if diagnosed with COVID-19. Other services, including but not limited to: BRCA testing and testing for large genomic rearrangements, You’re using the drug to treat something we cover, Your doctor prescribes it in a medically appropriate way. For members who have prescription drug coverage through Independence Blue Cross (Independence), prior authorization is required for certain prescribed formulary drugs in order for such drugs to be covered. Here you can access helpful information related to the program. The protection of your privacy will be governed by the privacy policy of that site. } Because we’re in this together. margin-right: 10px; Prior authorizations are a pre-service medical necessity review. Please review the terms of use and privacy policies of the new site you will be visiting. In most cases, your physician or facility will take care of requesting precertification. There are services and procedures that must be authorized prior to being performed. This is called prior approval, precertification or preauthorization. To learn more, refer to the Availity Authorizations & Referrals page located in the Provider Tools section. ... conducts utilization management as the delegated vendor for Advanced Imaging/Radiology, Sleep Disorder Management and Genetic Testing. The requirement applies when services are performed in an outpatient or office site of care. Blue Cross and Blue Shield of New Mexico (BCBSNM) has contracted with eviCore Health TM (eviCore) * to provide certain utilization management preauthorization services for Medicare Members. Referrals are required under the HealthSelect of Texas plan. We provide health insurance in … The following information describes the general policies of Blue Cross Blue Shield of Wyoming and is provided for reference only. Federal Employee Program, Blue Cross and Blue Shield's Federal Employee Program, Inpatient residential treatment center admission. To support the benefit change that is being implemented for many of your PPO patients Blue Shield of CA and NIA are educating providers about facility options available for the delivery of advanced imaging diagnostic services ordered.
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