CareCentrix^® to manage prior authorizations for home health care for Medicare Advantage members

Blue Cross Blue Shield of Michigan and Blue Care Network have contracted with CareCentrix to manage authorization of home health care for Medicare Advantage members.

For dates of service on or after March 1, 2021, providers will need to request prior authorization from CareCentrix for Medicare Plus Blue℠ and BCN Advantage℠ members for home health care.

CareCentrix will authorize and support the coordination of home health care services, such as skilled nursing and physical, occupational and speech therapies.

Submitting prior authorization requests

Primary care providers, acute care providers, post-acute care providers, and home health care agencies will be able to submit requests online through the CareCentrix portal, by phone, by fax and through AllScripts^®.

How does this benefit your patients?

This home health care program is designed to:

• Reduce the length of stay in inpatient facilities.
• Lower the chance of hospital readmission.
• Assist with the transition from hospital to home.
• Provide a home-based center of care.

Claims and appeals

Home health agencies will continue to submit claims, claims questions and appeals to Blue Cross Blue Shield of Michigan.

If providers do not obtain authorization for home health care from CareCentrix, claims may be denied.

Next steps

In future newsletter articles and web-DENIS messages, we’ll provide more information about CareCentrix and this change, including:

• Detailed information about portal access and the prior authorization process
• How to sign up for training webinars
• How to access resources and support