CareCentrix processes improved for Medicare Plus Blue prior authorization requests

We’re improving the prior authorization process for home health care services for Medicare Plus Blue℠ members who receive services in Michigan.

Clinical questionnaire available for Medicare Plus Blue

Starting Nov. 14, 2022, when submitting prior authorization requests for Medicare Plus Blue members who receive services in Michigan, a new clinical questionnaire opens in the CareCentrix HomeBridge^® portal.

Completing the clinical questionnaire expedites the review process and enables CareCentrix to make authorization determinations more quickly.

You can find reference materials about the clinical questionnaire in the HomeBridge portal. To access the portal:

1. Log in to our provider portal (availity.com**).
2. Click on Payer Spaces in the menu bar and then click on the BCBSM and BCN logo.
3. Click on the CareCentrix Provider Portal tile in the Applications tab.

In addition, CareCentrix has recorded trainings about the questionnaire. To access the trainings:

1. Go to carecentrixportal.com/providerportal.**
2. Click on the Review button under Provider Education and Documentation.
3. Click on BCBSM Home Health Reference Material under Education Center.

Individual training is available upon request.

The clinical questionnaire already opens for BCN Advantage℠ members.

HIPPS code optional when submitting prior authorization requests for Medicare Plus Blue

Currently, CareCentrix requires providers to enter the health insurance prospective payment system, or HIPPS, codes when submitting prior authorization requests for Medicare Plus Blue members who receive services in Michigan. Blue Cross Blue Shield of Michigan also requires that the HIPPS code on the prior authorization match the HIPPS code on the claim for home health services.

As of Nov. 14, 2022, CareCentrix and Blue Cross made the following changes based on feedback from and collaboration with home health agencies:

• CareCentrix no longer requires that you enter the HIPPS code when submitting prior authorization requests.
• You’ll still see the question, “Do you have the current HIPPS code for this requested period?” on the questionnaire. You can choose to enter the HIPPS code, or you’ll be able to select “No” as your response. 
• Blue Cross no longer requires that the HIPPS code on the claim match the HIPPS code on the prior authorization. We expect providers to bill according to Centers for Medicare & Medicaid Services billing guidelines.
• For more information about billing guidelines and audit protocols, see the “Utilization management” and “Medical records” sections of the Medicare Plus Blue PPO Provider Manual.

Additional information about home health care

For more information about the CareCentrix home health care program, see the following pages on our ereferrals.bcbsm.com website:

• Blue Cross Home Health Care
• BCN Home Health Care

CareCentrix is an independent company that manages the authorization of home health care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.