We’re extending the retro-authorization period for eviCore MA PPO and commercial PPO programs

Previously, we communicated about prior authorization programs administered by eviCore healthcare for Blue Cross Blue Shield of Michigan commercial PPO and Medicare Plus Blue^SM members.

Now, Blue Cross is extending the retro-authorization period from 90 days to 365 from date of service for the eviCore authorization programs.

This will apply to:

• Blue Cross commercial PPO
• Radiation oncology
• Interventional pain management
• Spinal fusion
• Medicare Plus Blue
• Radiation oncology
• Interventional pain management
• Spinal fusion
• Physical therapy and occupational therapy

It’s crucial that providers continue to check eligibility and complete the authorization prior to initiating any services. Keep in mind that the timely filing rules for claims will apply, and claims will be denied if the claim receipt date is greater than 365 days from the date of service. Providers must resubmit any previously denied claims in order for them to be reconsidered.

We encourage providers to complete retrospective authorizations as soon as possible to allow for claims submission and payment within the timely filing rules.

Note: MESSA and auto groups are excluded from the eviCore prior authorization program. Blue Care Network HMO^SM isn’t affected by this change.