Look for status note in e-referral system when we pend prior authorization requests for some services

In the Blue Cross Blue Shield of Michigan and Blue Care Network e-referral system, we’re adding a status note to let health care providers know when we’ve pended prior authorization requests for initial admissions to and extensions of stays in:

• Acute (non-behavioral health) inpatient hospitals
• Skilled nursing facilities, acute inpatient rehabilitation facilities and long-term acute care hospitals — for commercial members only
  Note: As a reminder, naviHealth manages these requests for Medicare Plus Blue℠ and BCN Advantage℠ members.

We recently implemented this function to make it easier for providers to see the status of their requests. Here’s how it works:

When a Blue Cross or BCN Utilization Management staff member pends a prior authorization request for review by a medical director, a status note appears in the upper-left portion of the Inpatient Authorization Details screen.

The status note says, “Request is being reviewed by physician,” as shown below.

The status note is displayed for Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage requests that are managed by the Blue Cross and BCN Utilization Management department.

When we make a determination on the request — whether an approval or a denial — you’ll no longer see the status note.

Previously, when we pended a request, we added a statement to that effect in the Case Communication field.

naviHealth is an independent company that manages authorizations for post-acute care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have a Medicare Advantage plan.