Blues to launch Electronic Provider Access tool

As part of our ongoing efforts to make it easier for you to do business with us, we’re launching a new tool Jan. 1, 2014, that will give you access to other Blue plan provider portals for the out-of-state members you treat.

The Electronic Provider Access tool will allow you access in order to conduct electronic preservice reviews, including prenotification, precertification, preauthorization and prior approval. It also will give health care providers outside of Michigan  access to the BCBSM provider portal for electronic preservice reviews.

Please note that Blue Care Network will not be launching the tool until later in 2014.

With this tool, you’ll use Provider Secured Services to gain access to a member’s home plan provider portal through a secure routing mechanism. Once in the out-of-state Blue plan’s provider portal, you’ll have the same access to electronic preservice review capabilities as that Blue plan’s local providers.

The availability of Electronic Provider Access on Jan. 1, 2014, will vary depending on the capabilities of each out-of-state member’s Blue plan at that time. Some plans may have fully implemented this tool’s capabilities, others may only allow preservice review for certain services, and others may not have implemented any electronic preservice review capabilities.

The following describes how to use Electronic Provider Access and what to expect when attempting to contact plans at different stages of implementation. 

How do I get started using this tool?
The first step for health care providers is to go to the BCBSM website and log in. You will then select the Conduct Pre-Service Review for Out-of-Area Members menu option. See screen shot below.

Next, you will be asked to enter the alpha prefix from the member’s ID card. The alpha prefix is the first three alpha characters that precede the member’s ID number.

Please note that you can check first whether precertification is required by the member’s home plan by:

• Sending a service-specific request through BlueExchange
• Accessing the home plan’s precertification requirements pages by using the Medical Policy/Pre-Auth Router.

What will happen once I am routed to the home plan provider portal?
Entering the member’s alpha prefix for preservice review will automatically route you to the home plan’s Electronic Provider Access landing page. This page will welcome you to the Blue plan portal and indicate that you have left BCBSM’s portal. The landing page will allow you to connect to the available electronic preservice review processes.

Because the screens and functionality of a plan’s preservice review processes vary widely, home plans may include instructional documents or e-learning tools on the landing page to provide instructions on how to conduct an electronic preservice review. This page will also include instructions for conducting preservice review for services where the electronic function is not available.

The home plan’s landing page will look similar across Blue plans, but will be customized to the particular home plan based on the electronic services the plan offers.

Are there situations in which I will not be routed to the member’s home plan?
In some instances, you’ll receive an error message when you enter the alpha prefix. This error message may indicate that you have not entered the appropriate number of alpha prefix characters or that the alpha prefix is inactive. (The alpha prefix may become inactive if a group with a unique alpha prefix moves to another carrier or plan.) If you encounter this error, please be sure to verify the three-letter alpha prefix on the patient’s ID card.

In other cases, you will receive a message with further instructions for conducting preservice review. For example, a provider may receive the following alert if they attempt to enter an alpha prefix for a Kansas City member:

“Blue Cross and Blue Shield of Kansas City does not currently conduct electronic pre-service reviews. Please call 555-555-5555 for preservice review.”

Note regarding Federal Employee Program members: Federal employee contract numbers, which begin with the letter “R” and don’t include a three-letter alpha prefix, are not supported by Electronic Provider Access.

What if I enter the alpha prefix and nothing happens?
We hope that these situations are infrequent as we work through early implementation issues. But if this should happen, providers can always call 1-800-676-BLUE to be routed to a plan for telephone preservice review.

If you have any questions about the EPA tool, please contact your provider consultant.