provider online tool demo - prospective reviewprovider (search by name or npi). if searching by...
TRANSCRIPT
Prior AuthorizationSee if a code needs review, submit authorization, and check request status
Provider Website and
Online Tools User Guide
An Independent Licensee of the Blue Cross Blue Shield Association© 2018 Premera. Proprietary and Confidential 036791 (10-2019)
Show me how to:
• See if a code requires review
– Quick code check: no log-in required, includes medical and dental,(not patient specific)
– Prior authorization tool: log-in required (patient specific)
• Submit a review
• Upload supporting documentation
• Check status of a review
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See if a code needs review:Quick code check
The code check tool is available atpremera.com/codecheck
or on your secure MyPremera dashboard.
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The code check tool is available at premera.com/codecheck
or on your secure MyPremera dashboard.
See if a code needs review:Quick code check
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The code check tool tells you if areview is required. Take a screen
shot or print results for yourrecords.
Prior authorization tool:Log-in required
• See if a code requires review– This tool gives you patient-specific information and verifies member
eligibility.
• Submit a review – instant reference number provided– Upload and attach supporting documentation for your request.
• Check review status – even if you didn’t submit the request online
• Tool now accepts the following types of requests:– Durable medical equipment (DME)– Inpatient admission notifications/confinements
• Providers outside of Washington and Alaska:– Log in to the Blue plan's website in your service area to find tools for
out-of-area members. They'll route you to our prior authorization tool.
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Prior authorization tool:Check a code and submit your review
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Start your search using the member ID or name
and date of birth.
If you submit a request, we’ve included a list of
what you’ll need to complete your request.
Date of service
Next, enter the date of service. The tool
verifies member eligibilityfor the date entered.
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Enter the date of service.The tool verifies membereligibility and benefits for
the date entered.
Type of service
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Select the type of service being performed.
Service details for type of service - inpatient
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Select the details about the inpatient service
being performed.
Check codes
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Enter the primary diagnosis code for the service being requested.
Enter yourprocedure codes.
Next steps
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Scroll to see your results.Here you’ll see if the service is a covered member benefit,
if review is required, or handled by AIM or eviCore
healthcare, why it’s reviewed, and what documentation to submit with your request.
We’ll also include a medical policy link, if applicable, and tell you if the member’s plan
has referral requirements.
If you have codes that say review is required, select
“Next” to start yourreview request.
Start your request: DME request example
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For durable medical equipment (DME) requests, tell us if the
patient is renting or purchasing, the quantity, months, and price.
Start your request: Prescribing/ordering provider
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Enter the name of the prescribing/ordering provider
(search by name or NPI). If searching by name, enter the
first two letters of thefirst and last name.
Additional information: Servicing provider
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Select Yes if the prescribing/ordering provider is also providing the service. If not, you’ll be prompted to
add the name of the servicing provider (search by name or NPI). If searching by name, enter the first two letters of
the first and last name.
Additional information: Services in a hospital/facility example
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If you can’t find the hospital/facility in thesearch feature, check the box for “Cannot find the
facility…” and manually add it to your request.
If the service is at a hospital/facility,enter the hospital/facility name.
This allows them to check review status.
Upload supporting documentation
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When you select Attach files,a window opens so you can
select documents to submit.
Attaching records ensures we haveeverything we need to review your
request. Look at the Documentationrequired & policies column for
details. You must attach at least 1 document to complete a request.
Enter notes
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Use the Notes field to provide moreinformation about your request, such as additional diagnosis codes, modifiers,
service date spans, etc.
Review before submitting
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Review your request. Afteryou submit, you won’t beable to make changes orattach additional records
unless we ask formore information.
Be sure to add your phoneand fax numbers in case we
have questions.
Confirmation page
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The confirmationpage includes a
reference ID number for your
records.
Your request will automatically show
as pending.
Auto approval
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In some cases, you may receive auto approval for a service so you
won’t need to submitany documentation.
You’ll have a referenceID number for your
records.
Check status
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You can check the status of a revieweven if it wasn’t submitted online.
Simply search by member or reference ID number.
Status: Search results
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Find your requestfrom the list and
select theReference ID link.
Status:Summary
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View the status ofyour request with
line-by-lineinformation that
includes procedurecodes, service
details, and contactinformation.
More information
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To learn more about our priorauthorization program, select
About Prior Authorization in theUtilization Review menuon our provider website.
Contact us
An Independent Licensee of the Blue Cross Blue Shield Association© 2018 Premera. Proprietary and Confidential 036791 (10-2019)
OneHealthPort user ID registrationwww.onehealthport.com/sso/register-your-organization
Technical issuesContact our Service Desk at 800-722-9780or email [email protected]
FeedbackVisit our secure provider website and give us your feedback through our Premera Listens link.