Preauthorization for Medicare Advantage PPO outpatient PT and OT coming in January

As communicated in the September and October issues of The Record, Blue Cross Blue Shield of Michigan, in partnership with eviCore healthcare, is expanding its physical therapy use management program to include a preauthorization component.

Effective Jan. 1, 2017, outpatient physical and occupational therapy services for Blue Cross Medicare Plus Blue^SM members who reside in Michigan will require preauthorization. Preauthorization will be based on category assignments that are determined by 12 months of independent PT and outpatient PT claims data (both MAPPO and commercial PPO data). For details on category assignments, see the September Record.

eviCore will mail letters to providers of PT and OT services, identifying their category assignments, by mid-November. If you don’t receive a letter, contact eviCore Customer Service at 1-877-917- BLUE (2583).

Training opportunities
Blue Cross will host two seminars on the program expansion at the Lyon Meadows Conference Center on Nov. 7, 2016. A webinar of the seminars will be made available.

In addition, interactive webinars will be held throughout November and early December. The webinars will provide more detailed information about preauthorization requirements in relation to your category assignment. See the October Record for registration information.

Preauthorization
Beginning Dec. 19, 2016, you can request prior authorization online and locate the clinical worksheets and CPT code list for outpatient physical and occupational therapy services by logging in to web-DENIS.

• Click on Prior authorization.
• Enter the NPI and contract number.
• Select the service for which you are requesting prior authorization.
• Click “OK” to be redirected to the eviCore healthcare web portal and proceed with authorization.

Requests for preauthorization can also be submitted by phone at 1-877-917- BLUE (2583) or by fax at 855-774-1319, but the fastest way to obtain authorizations is online. If a prior authorization isn’t obtained for these services, claims will be denied and the provider will be responsible for the costs.

For more information
The eviCore implementation website** provides additional information, including fax forms, national guidelines, Frequently Asked Questions, Quick Reference Guide and webinar details.

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