Medicare Plus Blue^SM post-acute care prior authorization process changing June 1

Effective June 1, 2016, prior authorization for inpatient admissions to skilled nursing facilities, long-term, acute care facilities and inpatient rehabilitation facilities for Medicare Plus Blue members will be handled by eviCore healthcare.

EviCore healthcare is a national specialty benefit management company that focuses on managing quality and use for individual patients.

Note: This process is for Blue Cross Blue Shield of Michigan providers and members for post-acute care services provided in Michigan.

For dates of service on or after June 1, 2016, providers will need to contact eviCore at 1-877-917-2583 (BLUE) to request prior authorization for skilled nursing facility, long-term acute care or inpatient rehabilitation facility admissions. EviCore healthcare will authorize the admission and length of stay.

Any admissions that takes place before June 1 will be handled according to the current process.

In the case that a prior authorization request is denied, you’ll have an opportunity for a peer-to-peer conversation. If you have any questions, contact your provider consultant.

Training on the new process will be announced on web-DENIS soon.