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May 2021

CareCentrix to manage authorizations for home health care for Medicare Advantage members

Action item

Referring providers and home health care agencies should sign up for training webinars on the home health care program for services managed by CareCentrix.

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

For episodes of care starting on or after June 1, 2021, providers will need to request prior authorization from CareCentrix for Medicare Plus BlueSM and BCN AdvantageSM members.

For episodes starting prior to June 1, 2021, providers will need to request prior authorization in the following situations:

  • Recertification is needed.
  • Resumption of care is needed.
  • Significant change in condition occurs.

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

The CareCentrix program will:

  • Use evidence‑based guidelines, including those from InterQual® and the Centers for Medicare & Medicaid Services, and clinical documentation to make utilization management decisions.
  • Validate appropriate utilization and enhanced quality of care across home health services.
  • As needed, assist with coordinating member transitions from hospital to home.

Submitting prior authorization requests

Home health care agencies will be able to submit prior authorization requests starting May 28, 2021. They can submit these requests online through the CareCentrix HomeBridge® portal, by phone or by fax.

CareCentrix will provide detailed information to home health agencies about the steps required to submit prior authorization requests during the upcoming webinar training sessions.

Registering for webinar training

We’re offering training webinars on the home health care program for services managed by CareCentrix. There are training sessions for referring providers and for home health care agencies.

Webinar for referring providers — This session will cover the CareCentrix home health care program and details about members’ transitions from hospital to home.

Date Time Registration
Tuesday, May 11, 2021 10 to 11 a.m. Click here to register

Webinars for home health care agencies — These sessions will cover the CareCentrix home health care program: the steps required to obtain prior authorizations for home health care services, intent to deny, peer-to-peer and appeal processes, and provider support and resources.

Date Time Registration
Tuesday, May 4, 2021 10 to 11:30 a.m. Click here to register
Tuesday, May 4, 2021 2 to 3:30 p.m. Click here to register
Wednesday, May 5, 2021 10 to 11:30 a.m. Click here to register
Wednesday, May 5, 2021 2 to 3:30 p.m. Click here to register
Thursday, May 6, 2021 10 to 11:30 a.m. Click here to register
Thursday, May 6, 2021 2 to 3:30 p.m. Click here to register
Tuesday, May 11, 2021 2 to 3:30 p.m. Click here to register
Wednesday, May 12, 2021 10 to 11:30 a.m. Click here to register
Wednesday, May 12, 2021 2 to 3:30 p.m. Click here to register
Thursday, May 13, 2021 10 to 11:30 a.m. Click here to register
Thursday, May 13, 2021 2 to 3:30 p.m. Click here to register

Learning more about the CareCentrix home health care program
We’ll publish a Home health care: Frequently asked questions for providers document soon. When it’s ready, we’ll post a web‑DENIS message to let you know about it.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.