Reminder: Medicare Plus Blue^SM PPO prior authorization program expansion and training webinar

As you read in the August Record, Blue Cross Blue Shield of Michigan will expand its prior authorization program later this year to include three additional services for our Medicare Plus Blue^SM PPO members who reside in Michigan and use Michigan providers.

The expansion is intended to eliminate the unnecessary use of certain procedures to improve patient care and manage health care costs. Following are the three additional types of services, the purpose of prior authorization for these services and the effective dates.

Starting Sept. 1, 2016:

• Inpatient and outpatient lumbar spinal fusion surgery — Manage the utilization of spinal fusion surgeries to ensure clinical appropriateness
• Outpatient interventional pain management — Manage the use of outpatient interventional pain procedures, including epidural injections, facet block and radiofrequency ablations, to help eliminate inappropriate delivery of such procedures

Starting Nov. 1, 2016:

• Outpatient radiation oncology — Manage the use of radiation therapy inclusive of modalities, dosing, coding and treatment goals, while reducing expenditures and the patient’s exposure to radiation therapy

For interventional pain management and lumbar spinal fusion surgery dates of service starting Sept. 1, prior authorization requests may be submitted on eviCore’s website**or by phone at 1-877-917-2583 (BLUE). The recommended and quickest way to obtain authorizations is online. If a prior authorization isn’t obtained for the above services, claims will be denied and providers will be responsible for the costs.

You can request a prior authorization online and locate the clinical worksheets and CPT code list for the mentioned services one of the following ways:

• At the eviCore implementation website**
• At the Blue Cross website. Go to bcbsm.com, click on Provider Secured Services, then log in to web-DENIS to find the authorization information.

The clinical worksheets will give you the information you need to request a prior authorization. The eviCore implementation site also includes Frequently Asked Questions, a Quick Reference Guide, national guidelines and information on webinars.

Training webinars
We published the full training webinar schedule for interventional pain management and lumbar spinal fusion surgery in a web-DENIS message posted Aug. 4. The remaining September webinars are listed below, as well as the times and dates for the outpatient radiation oncology webinars:

You can sign up for webinars at medsolutions.webex.com**

• Click on the Training Center tab at the top of the page.
• Click on the Upcoming tab, then find the date and time of the session you want to attend.
• Click on Register and enter the registration information.

Note: The webinar times listed on the website are Central time; the times listed above are Eastern time.

We’ll continue to provide more details about these changes in future issues of The Record and in web-DENIS broadcast messages.

**Blue Cross Blue Shield of Michigan does not own or control this website.