This article is for providers who use Authorization Manager to submit requests for musculoskeletal services
Thank you for using Authorization Manager to submit your requests for musculoskeletal services!
After reviewing your submissions over time, we’ve compiled some of the most common errors below, with tips on how to avoid them. We hope this information helps to improve the accuracy of your requests, minimizes pended cases that require manual review, and allows for an overall more efficient process for you.
| Common errors | How to avoid making mistakes |
|---|---|
|
Selecting the patient’s age |
If the patient is 18 years or older, choose the top option: If the patient is under 18 years old, choose the bottom option: Note: Some procedures, such as knee replacements, are not appropriate for patients under 18. If you select the incorrect age, your request may pend for manual review. |
|
Selecting number of symptoms |
If the patient has two or more symptoms based on their clinical documentation, then select at least two symptoms from the list when prompted.
If you don’t select at least two symptoms when the patient does have them, your request will pend for manual review. |
|
Selecting unilateral versus bilateral knee replacements |
If the patient will have one knee replaced, then select “Yes” when asked if a unilateral knee replacement is planned.
Choosing “No” implies that the surgical plan is to perform bilateral knee replacements (both knees replaced during the same surgery). |
|
Selecting a Medicare subset for Medicare Advantage |
For Medicare Advantage members, you must select a Medicare subset when applicable, followed by a Jurisdiction. For Massachusetts, the appropriate Jurisdiction is National Government Services (NGS).
|
We’re here to help
- If you need help with or have questions about Authorization Manager, email us at HMMAuthorizationManager@bcbsma.com
- For clinical inquiries on InterQual®, email us at MSKInterqual@bcbsma.com
More resources
- Authorization Manager Provider Central page, which contains helpful tips, guides, and video demonstrations
- Authorization Manager User Guide
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