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Premera Requiring Pre-Authorization on Outpatient Rehabilitation Services Effective 7/1/2016

Friday, June 17, 2016   (2 Comments)
Posted by: Sheri Ryan
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ACS Member Update 
Friday 17 June 2016






Did you Know?  Pre-authorization of Outpatient Rehabilitation Services for Premera Plans will be required 7/1/2016 through eviCore Healthcare.    Are you ready?  ACS has a plan...

Premera Blue Cross Blue Shield of Alaska issued a NEWSBrief on 03/28/2016 that announced effective July 1, 2016, they would be implementing an authorization and medical necessity review process for outpatient rehabilitation services.  eviCore healthcare will be managing outpatient rehabilitation services for Premera.  Effective 7/1/16, outpatient rehabilitation services from physicians, practitioners, and facilities will require a medical necessity review authorization from eviCore healthcare.  Here's a link to Premera's website and the effected rehab codes Premera Pre-Authorization.  This could have the potential to negatively impact your practice.  

Starting June 17, you can create an account and/or initiate an authorization for dates of service on or after July 1, 2016:  

  • Visit eviCore healthcare
  • Call 800-792-8751 from 7 am to 7 pm local time Monday through Friday
  • Fax an eviCore healthcare request form (available online) to 855-774-1319

Visit eviCore healthcare's website where you'll find the following helpful information:

 

Need help navigating the process?  The Alaska Chiropractic Society has worked out a DEAL for ACS Members with Dr. Tom Necela, the Strategic Chiropractor, for training on what your office should do to prepare.  With this DVD training, you will learn:

  • Why Premera's pre-authorization program has the potential to negatively affect 48% of your practice and your income (and what you can do about it!)
  • What three (3) front desk procedures should receive the bulk of your attention, energy, and focus. (If you focus on these three procedures, you can ignore almost all the others and still increase profits.) This is about focus. Pay attention to these three procedures and you'll do great. Ignore them and you'll struggle.
  • How to effectively communicate the pre-authorization process to your patients (he'll show you 4 simple talking points to tell your patients, so that you can avoid disrupting your patients' care.)
  • Diagnosis coding and treatment plan strategies that will help you defend your care from the pre-authorization attack (Hint: These two tactics will boost your authorizations from 33% to 85%.)

Alaska Chiropractic Society Members - Contact ACS at 907.903.1350 or sryan@akchiro.org for a promo code to use at checkout to SAVE $20 and get the DVD for $79 instead of of $99!  http://www.strategicdc.com/premera-webinar

How to Navigate Premera's Upcoming 
PreAuthorization Program

 







Manage your deposits from the comfort of your own office with Chiropractic Remote Deposit.  There are no fees and CFCU provides you with the equipment you need. Deposits made by 2 pm (EST) receive same-day credit, and deposits after 2 pm can be viewed in your account the next day.  When you need support a Help Desk is available 8 am - 7 pm for scanner and software issues, or your CFCU staff is standing by to assist you.  Chiropractic Remote Deposit is a GREAT solution for your business.  To get started, call CFCU at 248.478.4020.

Comments...

Sheri Ryan says...
Posted Friday, June 17, 2016
Per an ACS Member office - when requesting authorization: For the ordering physician, you will want to use your group NPI, if applicable. For the site/facility, you will want to use the treating doctor's individual NPI. (We know this seems backwards but that's what eviCore confirmed). Therapies will be under a MSMPT request. Massage will be under a MSMMT request.
Sheri Ryan says...
Posted Friday, June 17, 2016
Per an ACS Member office - This is only for local Premera Blue Cross plans and does not include out of state or Federal plans. Self-funded plans may or may not be included (it is their choice) and this can be checked when doing a benefits verification. Be aware: the status of a self-funded plans inclusion could change at any time. Treatment can be done on the initial visit and will be covered no matter what if it is billed with an exam. For patient's in the middle of treatment as of July 1st, send the original treatment plan and all current notes following that plan for approval.

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