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Premera Pre-Authorization Update #2

Friday, June 24, 2016   (0 Comments)
Posted by: Sheri Ryan
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ACS Member Update #2 
Friday 24 June 2016






Did you Know?  Select CPT codes provided in chiropractic offices will now fall under the NEW Pre-authorization program for Outpatient Rehabilitation Services for some Premera Plans effective 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 select 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.  NOTE:  This requirement may not apply to all Premera patients.  Continue to use your online tools to verify if a patient is part of the program as eligibility may change monthly.  ​This pre-authorization is not limited to Premera Preferred Providers.  The pre-authorization applies to all providers who bill for the select CPT codes under effected Premera plans.  

 

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 and more:

  • FAQ - This has some REALLY VALUABLE INFO - CHECK IT OUT!  Here's a few highlighted items:  Medical necessity authorizations are typically approved for a 30-day period.  However, periods may be shorter or longer depending on the member's conditions and timing of the request.  If medical necessity can be established based on evidence-based criteria, visits will be authorized at the time of your treatment request submission.  When you submit online, this authorization will be instantaneous.  Requests requiring clinical evaluation will be reviewed by appropriate specialty clinicians...

  • Webinar Trainings provided by eviCore - June 29, June 30, + July 7.  They will discuss in detail the prior authorization requirements for Premera members and how to locate additional training materials to navigate the eviCore Web site.  Topics to be discussed include the new prior authorization process, accessing information from the Website and a review of the Quick Reference Guides.  Time and participation permitting, this orientation session will be followed by a question and answer session.  You are encouraged to attend one of these informative sessions to ensure your understanding of the NEW prior authorization process for these select MSK Services.  NOTE:  PRE-AUTH DOES NOT CONTAIN CMT codes - ONLY SELECT THERAPY CODES
  • Quick Reference Guides
  • Clinical Guidelines for Chiropractic Services - this link is provided so you can get a feel for how eviCore's determination of medical necessity and the therapies associated with certain chiropractic conditions.  Remember - Premera has only contracted with eviCore to do pre-authorization on a select list of CPT Codes that fall under Outpatient Rehabilitation Services.  Any other restrictions listed in this guideline (X-ray, E/M, CMT, etc.) DO NOT APPLY!  
  • Clinical Guidelines for Massage Therapy 
  • Massage Therapy Treatment Request Clinical Worksheet - use for 97124 and 97140
  • PT/OT Treatment Request Clinical Worksheet - use for all other therapies (97010, 97012, 97014, 97026, 97028, 97035, 97110, 97112, etc.)
  • Tutorial for Online Submission Process for MSK
  • Provider Orientation
  • Set up a Provider Account with eviCore
  • Provider Web Portal Quick Access Guide
  • CPT Code List - this NEW pre-authorization ONLY APPLIES TO THESE CODES!!
  • Medical Necessity Review Authorization Request (available through the Clinical Certification online tool)

 

Here's some helpful info that has come in from ACS Member offices... 

 

Therapies will be under a MSMPT request. Massage will be under a MSMMT request.

 

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.







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.


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Alaska Chiropractic Society, PO Box 111507, Anchorage, AK  99511-1507 
    
Phone: (907) 903-1350   Fax:  (907) 770-3790   Email:  info@akchiro.org