Provider automated response system makes getting patient benefit information easier

Blue Cross Blue Shield of Michigan knows that your time is valuable and we want to make it as easy as possible for you to get benefits for your patients. Here’s information about a recent change and answers to some frequently asked questions about PARS:

Effective July 1, 2014, residential psychiatric benefits can be obtained by calling the Facility PARS phone line at 1-800-249-5103 and pressing benefit prompt number six (hospital inpatient).

Note: The Federal Employee Program^® does not currently use PARS.

Frequently asked questions

Q. Where can I find benefit information for diabetic supplies and testing?
A. Diabetic supplies and diabetes testing benefit information can be found by calling 1-800-344-8525, the professional provider IVR phone line, and pressing benefit prompt number six for durable medical equipment, orthotics and prosthetics. Please note that this benefit will not be found under benefit prompt number three for general practice.

Q. Why aren’t age limits referenced on PARS when I am checking benefits?
A. Due to recent mandates and the Health Care Reform law, there are now only a few benefits that have an age limitations. If you’re checking benefits and you do not hear an age limit specified on PARS, this means that there is no age limit for that benefit.

Q. What is the difference between precertification and preauthorization, and why can’t I call for precertification directly?
A. Precertification is a review of a patient’s symptoms and proposed treatment to determine, in advance, whether he or she meets BCBSM criteria for treatment in an inpatient setting. There are only three benefits that may require precertification and they are only on the facility provider IVR: acute inpatient, skilled nursing and rehabilitation setting. With these three benefit phone prompts, the IVR will indicate that precertification may be required, what benefits will be given and then the system will give the option for you to say “precertification.”

Preauthorization is a process that allows physicians and other professional providers to determine, before treating a patient, if BCBSM will cover a proposed service. BCBSM requires pre-authorization for services that may be experimental, investigational, cosmetic or not always medically necessary. This preauthorization is not done through the phone. Providers must submit clinical documentation in writing explaining why the proposed procedure is medically necessary. If you are having a procedure code pre-authorized, you will need to send a medical review request to BCBSM, only if a patient does not meet the criteria for a procedure. You can check the medical criteria in web-DENIS.

For services that require preauthorization, the professional PARS line will indicate this on the applicable benefit. For example, radiology services often require preauthorization through American Imaging Management. The professional provider IVR will advise this when checking benefits.