The way you look up authorizations is changing

Do you currently use web-DENIS to determine the status of authorization requests? If so, you’ll need to follow a different process going forward. Exactly how you’ll do it will depend on whether you’re the provider ordering the service or the provider rendering the service — and whether the service is managed by Blue Cross Blue Shield of Michigan or by one of our vendors.

Use e-referral to look up authorizations if:

• You’re the provider ordering the service — Effective Nov. 28, 2017, authorizations for services managed by Blue Cross vendors are now available on the e-referral system. Authorizations for services managed directly by Blue Cross have been available on e-referral since July 31, 2017. As a result, you can now find authorizations for Blue Cross PPO and Blue Cross Medicare Plus Blue^SM PPO, in addition to Blue Care Network and BCN Advantage^SM patients, on e-referral, regardless of whether the service is managed by Blue Cross, BCN or a vendor.
• You’re the provider rendering the service and the service is managed by Blue Cross (not a Blue Cross vendor) — If the service is managed by Blue Cross directly, you can find the authorization information on the e-referral system.

Use an alternate method of looking up authorizations if you’re the provider rendering the service and the service is managed by a Blue Cross vendor.

Effective Nov. 28, 2017, authorizations for services managed by Blue Cross vendors are moving to the e-referral system. However, rendering providers won’t be able to use e-referral to look up authorizations for services managed by a Blue Cross vendor as the rendering provider information isn’t available. We’re working to develop an online method of finding this information, which we expect to announce in 2018. Until then, you’ll need to use an alternate method to confirm authorization before rendering a Blue Cross vendor-authorized service.

Alternate methods of looking up an authorization

Here are the alternatives rendering providers can use to find an authorization for a service managed by a Blue Cross vendor:

• Request confirmation from the ordering provider — The ordering provider can look up the authorization on e-referral and inform the rendering provider if the service is authorized.
• Ask the patient to bring in his or her letter of authorization — The member can share a copy of the letter he or she receives with details on the authorization determination.
• Call Blue Cross Provider Inquiry — During business hours, you can speak to a Provider Inquiry representative to find an authorization by calling the appropriate Provider Automated Response System phone numbers and following the prompts below.**
• PARS will ask if you’re calling for claims, or eligibility and benefits.
• If you’re calling before the service has been rendered, and you need to know if authorization is required, you should choose Eligibility and Benefits.
• If you’re calling about authorization after the service has been rendered, and you have already billed a claim, you should choose Claims.
• Eligibility and benefits:
• PARS will ask for your Provider ID (NPI or Blue Cross pin/code).
• PARS will ask for your provider type/provider specialty.
• PARS will ask for the member information.
• ✔ Member contract number, date of birth, first name
• PARS will provide eligibility and general information.
• At this point, you can request a hardcopy of the benefits, or you can say “eligibility and benefits” to continue; cost share will then be provided.
• You must listen to at least one benefit before asking to speak to a representative. You can select the benefit you want to hear after you have heard the cost share information for the policy.
• After the benefit information is given, listen to the menu options and select “representative” when prompted.
• Claims:
• PARS will ask if you’re calling on behalf of a Michigan member.
• PARS will ask if the services were rendered in Michigan.
• PARS will ask for your Provider ID (NPI or Blue Cross pin/code).
• PARS will ask for the member information.
• ✔ Member contract number, date of birth, first name
• PARS will ask if you’re checking the status of your claim. You should answer “no” to this question.
• PARS will ask if you’ve received a voucher for the claim you billed. You should answer “voucher” to this question.
• PARS will ask the reason for your call. Select “follow up on a previous inquiry.”
• PARS will ask if you’re calling on the status of your claim, checking benefits and eligibility or if you would like to speak to a representative. Say “representative.”

Here are the PARS phone numbers for the different types of providers:

◦ Physicians and professional providers:	1-800-344-8525
◦ Hospitals or facilities:	1-800-249-5103
◦ Federal Employee Program® providers:	1-800-840-4505

Blue Cross vendor-authorized services include:

• AIM Specialty Health — Radiology management and sleep studies
• NovoLogix^® — Drugs covered under the medical benefit
• Beacon Health — Behavioral health
• New Directions — Behavioral health
• eviCore healthcare — Cardiac rehabilitation, radiation therapy and physical therapy

Note: eviCore is currently Blue Cross’ vendor for Medicare Advantage members and will become the vendor for commercial members beginning Jan. 1, 2018, for interventional pain management, radiation therapy (oncology) services, and inpatient and outpatient lumbar spinal fusion surgery.

Web-DENIS authorization information

The Authorization History section within web-DENIS Facility Claims will stop displaying current authorization information as of Nov. 28, 2017. Historical authorization information for periods before Nov. 28, 2017, will be available through the end of 2017.

For more information

More information about e-referral is available in our July 2017 Record article. Training materials are available on the e-referral Training page.

**These instructions are only for navigating PARS when checking on authorizations.