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News & Press: Insurance/Provider

Premera Change from eviCore to Evolent Health for INDIVIDUAL PLANS ONLY!

Monday, December 23, 2019   (0 Comments)
Posted by: Sheri Ryan
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Alaska Chiropractic Society

Premera BCBS of AK

Changes eff. 1/1/2020

Changes for Massage, Physical, and Occupational Therapy

Premera Provider News

Dear Alaskan Doctors and Office Managers,

This is to CLARIFY the Premera Blue Cross Blue Shield of Alaska Provider News Brief dated 11/21/2019 titled Changes for Massage, Physical, and Occupational Therapy-->https://www.premera.com/ak/provider/news/reminders-updates/changes-massage-physical-occupational-therapy/. This change affects INDIVIDUAL PLANS ONLY!

FYI - It is our understanding that Premera GROUP Plans will REMAIN under eviCore with prior-authorization requirements proceeding as usual.


How can you tell on a Premera Member ID Card if it's a group plan or an individual plan? See this Premera News Brief dated 12/5/2019 --https://www.premera.com/ak/provider/news/company-updates/member-id-cards-individual-plans/

Everything you need to know about 2020 Individual Health Plans -->https://www.premera.com/ak/provider/news/company-updates/about-individual-plans/


ACS Summary

Regarding the changes to use of Evolent Health for Individual Plans- Upon review of the code list - massage therapy services (97124 + 97140) and most physical therapy codes performed in a chiropractic office have a Plan Review Requirement listed as "Retrospective Review". This would mean that you are not required to get prior authorization for Premera Individual Plans or use Identifi with Evolent Health.

Many chiropractic offices offer a wide variety of services. Please review the code list(s) referenced in the email below for any massage or physical therapy services performed in your office to determine what the Individual Plan Review Requirement is for that service. Please note that these codes lists are subject to change. If the review requirement is "Prior Authorization Required", then proceed with the requirements for use of Identifi with Evolent Health as listed in the 12/12/2019 Premera News Brief below. If all services you provide have Retrospective Review listed as the plan requirement, it is not necessary to get prior authorization through Identifi with Evolent Health.


Premera put out a NEWS Brief dated December 12, 2019 titled Prior Authorization Process Changing for Premera’s 2020 Individual Plans - Updated Information!https://www.premera.com/ak/provider/news/company-updates/prior-auth-process-changing/with a detailed process.

Everything you need to know about 2020 prior authorizations

There are important process changes to submitting prior authorization requests for your patients with Premera 2020 Individual health plans.

Prior authorizations requests submitted through 12/31/2019:

  • Providers will use the current code list(028861.pdf) on the Premera website to see if prior authorization is required.
  • To submit a request through 2019, fax the current prior authorization request form to Premera Care Management.

Prior authorizations submitted on/after 1/1/2020:

  • There will be a new code list(050237.pdf) for Individual plans starting 1/1/2020 and most services will require prior authorization.
  • You have two ways to submit prior authorizations:

1. Online using Evolent’s prior authorization submission tool, Identifi, on the provider secure website.

  • You aren’t required to register with Identifi to start using it in January.
  • Once you sign into your OneHealthPort account on/after January 1, 2020 and click to access the new Premera 2020 Individual Plan secure site, you’ll be granted access to Identifi within 1-5 business days. You’ll receive a confirmation email once your access is granted. There aren’t any additional steps you need to take. If you need to submit a prior authorization during the 1-5 day waiting period, you can fax your submission using the instructions below, or call our utilization management team directly.
  • For questions about Identifi, our utilization management staff can answer your questions beginning on 1/1/2020 at our customer service line,800-607-0546.
  • You can also look at our step-by-step training(.pdf) on how to use Identifi.

2. Fax the new prior authorization submission form available on the Premera website under “Forms” and on the Individual secure site starting 1/1/20.

  • Individual market health plans aren’t using eviCore for outpatient prior authorizations. See our separate provider news story for more information on this.
  • Individual plans are using AIM Specialty Health for imaging prior authorizations.

Prior authorization requests spanning 2019-2020:

We understand you may have patients with existing/approved prior authorizations in 2019 for services in 2020. Our medical management team is tracking these cases and will follow the below protocol for prior authorizations spanning the plan years:

  • If the serving provider in 2020 is in-network and the benefit is covered then we’ll honor the 2019 prior authorization.
  • If the serving provider in 2020 is now out-of-network, the serving provider will need to submit a new prior authorization using the new code list. Our medical management team will fax back to providers if a new prior authorization is needed.

Please let ACS know if you have any questions or concerns regarding the information above.

A GREAT BIG SHOUT OUT to Caprice Simmons at Dr. Ross' office Excellence in Health for sharing this information with ACS!!

Best regards,

Sheri Ryan | Chief Operating Officer

Alaska Chiropractic Society
550 E. Tudor Rd., Suite 202 |Anchorage, AK 99503

Direct/Mobile: (907) 903-1350| Fax: (907) 770-3790

sryan@akchiro.org |Facebook|Twitter|Website

 


 


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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