Provider Alert | Provider Prior Authorizations

Submit requests for swallow services to BCN, not to eviCore healthcare

In this message, we're clarifying:

That BCN Utilization Management manages authorizations for outpatient swallow services for BCN HMO^SM (commercial) and BCN Advantage^SM members
That swallow services are handled separately from speech therapy, which is managed by eviCore healthcare
How to request approval for these services

Here's what you need to know.

Submit requests for swallow services to BCN

Requests for outpatient swallow services must be submitted to BCN Utilization Management through the e-referral system or by calling 1-800-392-2912.

Here are the requirements for these services:

Swallow evaluations (procedure code *92610) and swallow studies (procedure codes *92611 through *92617) require plan notification.
Swallow therapy (procedure code *92526) requires authorization. Determinations are made based on medical necessity review. You must submit clinical information along with the authorization request.

Refer to the e-referral User Guide for instructions on how to submit plan notifications and authorization requests using the e-referral system.

Submit requests for speech therapy to eviCore

Swallow evaluations, studies and therapy are handled separately from speech therapy, which is managed by eviCore healthcare.

Submit authorization requests for outpatient speech therapy to eviCore in one of the following ways:

Recommended: Use the eviCore healthcare provider portal at www.evicore.com.**
Alternatives: Call eviCore at 1-855-774-1317 or fax to eviCore at 1-800-540-2406.

We'll update our documents

We'll update the following documents to clarify the requirements for swallow services:

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Posted: January 2020
Line of business: Blue Care Network