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July 2017
Reminder: Changes to prior authorization processes coming soon
As you read in the April and June 2017 Record, there are three major changes coming to our prior authorization processes:
- Beginning July 5, 2017, we’ll require prior authorization for our Medicare Advantage PPO patients for select specialty medications administered in the provider’s office and covered under the Medicare medical benefit.
- Beginning July 31, 2017, prior authorization for Medicare Advantage patients will be required for select surgical procedures. Procedures will include the following:
- Arthroplasty (hip, knee, shoulder)
- Correction of hammertoe
- Nasal/sinus endoscopy
- Endovascular intervention, peripheral artery
- Radiofrequency ablation and transarterial embolization
- Vagus nerve stimulation
- Intrathecal catheter/pump placement
- Spinal cord stimulator insertion
- Gastric stimulation
- Beginning July 31, 2017, we’re moving from the prenotification system to e-referral. If you’ve been using the prenote system for services requiring prior authorization, you’ll be switching to e-referral.
Note: If you’re not an e-referral user already, you can sign up on the Sign Up or Change a User page on the ereferrals.bcbsm.com website. The page contains information providers need to sign up for access to the e-referral system.
The table in the June edition of The Record outlines all the prior authorization programs for MA PPO and commercial members, including the changes that are coming in July 2017.
Authorization for inpatients
The table below outlines authorization requirements for inpatient cases:
How can I get trained on e-referral?
We have an array of e-referral training opportunities and resources:
- e-referral webinars scheduled for July 27 or Aug. 31
- You can sign up by completing and faxing the webinar registration form to 1-866-652-8983 or email it as an attachment to ProviderInvitations@bcbsm.com. Instructions will be emailed to you a day or two before the webinar.
- e-referral online self-paced learning modules, which can be found on the e-referral website by clicking here.
- Training tools, such as the e-referral user guide and quick guide, which you can access from the e-referral website by clicking here.
- Your provider consultant. As always, you may reach out to your provider consultant to schedule a one-on-one meeting or a group training session.
More information on process changes
For information on the MA PPO prior authorization requirements for select specialty medications, see the article in this issue.
For more details on the upcoming changes, see the previous Record articles:
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