This article is for providers caring for our Medicare Advantage members
Effective Monday, February 17, 2020, our new modernized utilization management system for Medicare Advantage members goes live. As we previously communicated, this will change the way that we will notify you of prior authorization review results for your Medicare Advantage patients. This new system will not:
We plan to implement changes to prior authorization for our commercial and Federal Employee Program products at a later date. Until then, we will follow the current authorization processes for these members.
Maintenance for Online Services: Referrals and authorizations affected
From 7 p.m. Friday, February 14 until 7 p.m. Sunday, February 16, you will not be able to submit or check either referrals or authorizations. All other functionality will be available. You will be able to submit claims, access benefits and eligibility information, and submit faxes as usual. Pharmacy is not impacted.
Here is what to expect.
For | Starting February 17 |
---|---|
Requests pended for additional information | We will still fax you a letter detailing the clinical information we need to complete the review. |
Denials | We will still call you and send a copy of the member’s denial letter via US mail.
What’s new: You will be able to view the status of authorizations through our new utilization management system. |
Requests for prior authorization and status | Please continue to follow the current process to request prior authorization and status inquiries. What’s new:
|
Approvals | We will continue to send an approval letter via US mail. What’s new:
|
The automated fax-back program |
What’s new: We will no longer send an evening fax summary of all approvals, denials, and requests for clinical information. The new functions noted above will replace this program. |
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to your patients—our members.
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