Provider Alerts

Changes to prior authorization request process for endovascular intervention program starting April 26

e-referral system out of service for maintenance April 18-19

Avlayah IV and Kresladi IV to require prior authorization for most members starting April 6 and May 1

Additional medical benefit drugs to require prior authorization for Blue Cross commercial URMBT members starting July 1

Additional drugs to have a site-of-care requirement for most commercial and URMBT members starting July 1

e-referral system out of service for maintenance April 4-6

Additional Q&A sessions available for home health agencies about changes for Medicare Advantage home health care managed by tango

April 3 holiday closure: How to submit authorization requests for inpatient admissions

Changes to prior authorization requirements for select services managed by Blue Cross and BCN effective March 15

Additional drugs to require prior authorization for Medicare Advantage members starting June 22

TurningPoint's SmartScan software now available April 15, training Q&A sessions available

Pharmacists' scope of practice has expanded to include testing and treatment

Pharmacists' scope of practice has expanded to include hormonal contraceptives

e-referral system out of service for maintenance overnight March 21-22

Retraacted: Genio device to require prior authorization for commercial members starting May 1

Correction to list of Procedure codes for which providers must request prior authorization

Update: Learn more about tango’s management of home health care for Medicare Advantage members

Register for a Q&A session for home health agencies about changes for Medicare Advantage home health care managed by tango

Loargys to require prior authorization for most members starting March 9 and April 1

Update: Michigan Medicine to terminate its Southeast Michigan hospitals, facilities and professionals from Blue Cross and BCN commercial networks July 1

Additional drugs to have a site-of-care requirement for most commercial members starting June 1

Reminder: Tango to manage home health care for Medicare Advantage members starting March 1

TurningPoint introduces software to assist with the prior authorization process for select musculoskeletal procedures

Complete the Continuity of Care questionnaire in the e-referral system for some BCN commercial members starting Feb. 23

Musculoskeletal procedures may require prior authorization through TurningPoint for FEP members

Learn more about tango’s management of home health care for Medicare Advantage members

e-referral system out of service for maintenance overnight February 21-22

How we’re supporting the transition to tango for the management of home health care for Medicare Advantage members

We’re adding requirements for additional medical oncology drugs for most members starting May 13

Additional drugs to require prior authorization for Medicare Advantage members starting May 11

Change to authorizations for SNF interrupted stays for Medicare Advantage members

Prior authorization requirements for home health care services that start before March 1 for Medicare Advantage members

Register for training to learn about changes to home health care for Medicare Advantage members

Reminder: Home health agencies must contract with tango by March 2 to stay in network for Medicare Advantage members

Update: Tango to coordinate referrals, manage prior authorizations and process claims for home health care for Medicare Advantage members starting March 1

How to speed up the prior authorization process for Medicare Advantage SNF stays when submitting requests through the WellSky provider portal

Update: Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Feb. 1

Complete and attach the Prospective Editing Reconsideration Request Form when submitting requests through Availity Essentials

EviCore category assignments and practitioner performance summaries for PTs and OTs will be available Feb. 2

A new questionnaire for referrals to out-of-network providers will open in the e-referral system for some office visit codes

Correct mailing address, fax number for submitting appeals of denied inpatient admissions on behalf of Medicare Plus Blue members

Leqvio and Zusduri to have requirements for Blue Cross commercial URMBT members starting April 15

Yartemlea IV to require prior authorization for most members starting Jan. 19 and Feb. 2

Reminder: How to check member eligibility and benefits in Availity Essentials without member ID or member ID prefix

How to submit appeals of denied inpatient admissions on behalf of Medicare Advantage members to Grievance and Appeals

Jan. 19 holiday closure: How to submit authorization requests for inpatient admissions

e-referral system out of service for maintenance overnight January 17-18

How to search for members in e-referral and avoid the inactive eligibility status

Upload clinical documentation before launching Inspire V questionnaire in the e-referral system for commercial members

Medicare Advantage post-acute and home health care update, including additional information about tango

Register for a Q&A session about prior authorization changes for Medicare Advantage post-acute care

Changes to Medicare Advantage process for requesting additional clinical information for inpatient authorizations starting Jan. 1

Reminder: WellSky will manage prior authorization requests for post-acute care stays for Medicare Advantage members starting Jan. 5