November 5, 2020
We appreciate the feedback you’ve provided on effectiveness of communication channels, such as our Blue Review and Provider website. Whether you responded to a survey, sent an email, asked questions in a webinar or reached out by phone, we want you to know we’ve heard you and we’re making changes to help make it easier for you to work with us.
This week, we launched a new Utilization Management section under the Claims and Eligibility tab.
Previously the name of this section was Prior Authorization – we’ve updated the content for clarity and revised the format for ease of navigation.
- There’s a page for each type of pre-service medical necessity review: Prior Authorization, Predetermination and Pre-notification.
- Each page defines terminology and steps to assess if review is needed, and how to request it.
- Prior authorization code lists and other reference materials are found on the Support Materials (Commercial) and Support Materials (Government Programs) pages.
But we’re not done yet.
We’ll continue to refine and enhance this section of our website to help ensure the information is useful. Watch the News and Updates for announcements and links to new resources as they are added.
Checking eligibility and/or benefit information and/or obtaining prior authorization or pre-notification is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, contact the number on the member’s ID card.