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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Stephanie Cole
Healthcare Implementation Manager
Prepared for Physical Therapy Association of Washington
May 11, 2017
Provider Website Overview
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Agenda
• Introduction
• Quick Facts
• Live Demo Benefits
Code checks
Online resources
• Introduce eviCore
• eviCore Website Overview
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Website Overview
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Quick Facts
• Accessing all of our secure tools requires registration through
OneHealthPort (OHP)
• Our website is updated nightly
• Accumulators for physical therapy are available
• You can find the deductible, out-of-pocket and exclusions to the out-
of-pocket on our eligibility and benefits tool
• You can find two years of eligibility, claims and prior authorization
info online
• If the Managed Care Coordinator message appears when you’ve
selected physical therapy or massage therapy from the benefits
dropdown list, that indicates we require evICore review for that
member’s plan
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Online Resources
• Provider orientation and online tool guides premera.com/wa/provider/learning-center
• Eligibility and Benefits: Verify member’s eligibility and benefits,
effective dates and accumulators online.
• Prospective Review Tool: Check a code to see if review is
required. This provides a member specific response.
• Give feedback 24/7 with Premera Listens
• Provider News: Sign up for email alerts to stay up
to date
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
eviCore Website Overview
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
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Case Initiation
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Initiating A Case
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• Choose “request a clinical certification/procedure” to begin a new case request.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Program
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Select the Program for your certification.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Service Options
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Select Date Extension, Continuing Care, or Build a New Case.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Provider
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Select the Practitioner/Group for whom you want to build a case.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Health Plan
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Choose the appropriate Health Plan for the case request.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Select Address
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Contact Information
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Enter the Provider name and appropriate
information for the point of contact individual.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Member Information
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Enter the member information including the Patient ID number, date of birth, and patient’s last name. Click “Eligibility Lookup.”
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Clinical Details
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Verify Service Selection
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ICD-10 Code
ICD-10 Code
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Site Selection
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Verify all information entered and make any needed changes prior to moving into the clinical collection phase of the prior authorization
process.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Clinical Certification
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You will not have the opportunity to make changes after that point.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Finish Later/Save Option
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Once you have entered the clinical collection phase of the case process, you can save the information and return within (2) business days to
complete.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Medical Review
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If additional information is required, you will have the option to either upload documentation, enter information into the text field, or contact us
via phone.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Medical Review
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Acknowledge the Clinical Certification statements, and hit “Submit Case.”
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Approval
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Once the clinical pathway questions are completed and if the
answers have met the clinical criteria, an
approval will be issued.
Print the screen and store in the patient’s
file.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Building Additional Cases
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Once a case has been submitted for clinical certification, you can return to the Main Menu, resume an in-progress request, or start a new request. You can indicate if any of the previous case information will be needed for
the new request.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Authorization look up
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• Select Search by Authorization Number/NPI. Enter the provider’s NPI and authorization or case number. Select Search.
• You can also search for an authorization by Member Information, and enter the health plan, Provider NPI, patient’s ID number, and patient’s date of birth.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Authorization Status
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The authorization will then be accessible to review. To print authorization correspondence, select View Correspondence.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Eligibility Look Up
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
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Provider Resources
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Musculoskeletal Online Resources
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Clinical Guidelines, FAQ’s, Online Forms, and other important resources can be accessed at www.evicore.com. Click “Solutions” from the menu bar, and select the specific program needed.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
eviCore Provider Blog Series
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• The eviCore blog series focuses on making processes more efficient and easier to understand by providing helpful tips on how to navigate prior authorizations, avoid peer-to-peer phone calls, and utilize our clinical guidelines.
• You can access the blog publications from the Media tab or via the direct link at https://www.evicore.com/pages/media.aspx.
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Premera is an Independent Licensee of the Blue Cross Blue Shield Association
Web Portal Services-Assistance
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Email [email protected]
Call a Web Support Specialist at (800) 646-0418
(Option 2)
Connect with us via Live Chat
Web Portal Services-Available 24/7