web authorization submission bluecross blueshield of tennessee, inc., an independent licensee of the...
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Web Authorization Submission
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.BlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association,
An Association of Independent BlueCross and BlueShield Plans. CPT® is a registered trademark of the American Medical Association
This document has been classified as public information.
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Authorization Submission
Enter user ID and password to log in to the secure area of bcbst.com.
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Authorization Submission
Select “Commercial/BlueAdvantage/BlueCare/TennCareSelect to begin the authorization submission process.
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Authorization Submission
All Web functions can be accessed through the left-hand menu.
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Authorization Submission
Select “Patient Inquiry” to view benefits, claims and other coverage.
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Authorization Submission
All authorizations are initiated under “Authorization/Advance Determination Submission.”
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Authorization Submission
Authorizations for inpatient confinement, 23-hour observation, outpatient procedures, specialty pharmacy, global obstetrics, and clinical updates
can be submitted online.
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Authorization Submission
Select the appropriate authorization to begin the authorization process.
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Authorization Submission
Enter the requested admit date in MM/DD/YYYY format, then select a member by entering the appropriate member ID number
without the three-letter prefix, then select “Search.”
The yellow dot indicates the stage of the process.
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Authorization Submission
Highlight correct member and click.
Member information will auto-populate
into the correct fields.
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Authorization Submission
Enter Provider, Facility and Confinement Information.
(Note: the yellow dot has progressed to the next stage)
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Authorization Submission
Enter Provider and Facility ID numbers if known.
“Search” for Provider and Facility ID numbers if not known.
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Authorization Submission
Search for Providers by entering ID, name
or location, then clicking “Search.”
A list of possible matches will becreated. Click the correct providerto auto-populate the authorization request.
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Authorization Submission
Reminder: •All fields with an asterisk must be completed. •ICD-9 codes should omit decimals.•Dates are in MM/DD/YYYY format.
Emergency admits can be backdated four days.
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Authorization Submission
Select the appropriate options from drop-down menus.
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Authorization Submission
Procedure codes are only needed for elective surgery authorizations.
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Authorization Submission
Milliman Care Guidelines criteria are selected by default and are necessary to obtain immediate online authorization.
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Authorization Submission
Note any pertinent member co-morbidities/history in the text field. This note field can also be used to list secondary physicians,
diagnosis or procedure codes.
If Milliman Care criteria are not applied, supporting information is required here and the authorization request will be pended for review.
When this screen is complete, choose “Continue.”
•This field is required when option was chosen to skip
Milliman Criteria and pend to BCBST nurse for review.
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Authorization Submission
When the screen is completed, a summary screen will be shown.Please review the information for accuracy and provider network status.
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Authorization Submission
If changes are needed, click “Back” to go back and correct the information. When all information is correct, click “Continue.”
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Authorization Submission
Apply Milliman Criteria
The system will show the most appropriate guidelines, based on diagnosis or procedure codes entered. If one is appropriate, click the box next to
it and select “Continue.”
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Authorization Submission
Apply Milliman Criteria
You may also find guidelines by selecting “Show All Guidelines”and “Search Guidelines.”
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Authorization Submission
Click “Show All Guidelines” to bring up a drill-down menu. Click “+” to drill down to the appropriate condition, then select the guideline.
Authorization Submission
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This example is being searched by description. Select “Search” after entering code or description.
The “Search Guidelines” option will bring up a search screen and can be searched by ICD-9, CPT® Code or guideline description.
Authorization Submission
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Authorization Submission
The Search screen will bring up the guidelines most closely associatedwith your search criteria.
Select the appropriate guideline and click “Continue.”
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Authorization Submission
Select all that apply, then click
“Continue.”
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Authorization Submission
A summary screen will show selected criteria.
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Authorization Submission
If the clinical information submitted meets the criteria, an authorizationnumber will be given. Print this page for your records.
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Authorization Submission
If the guideline is determined to be more suited for 23-hour observation, the user can either accept the observation or request pending status for
further medical review.
If the physician is a Gold Card provider, the Gold Card option will be offered here.
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Authorization Submission
If you choose to pend the authorization for further medical review, a screenwill be generated to allow you to submit additional clinical information.
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Authorization Submission
Notes are required when the authorization is pended for further medical review. When notes are complete, choose “Finish.”
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Authorization Submission
Authorizations that pend will generate a confirmation number. The confirmation number may be used to check status of the request
online. A nurse will call with the decision.
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Questions?
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Authorization SubmissionClinical Update Submission
Select “Clinical Update” to update initial authorizations submitted on the Web.
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Clinical Update Submission
Use the Quick Locator to key in the confirmation or reference number and click “Go,” or double click the correct confirmation number.
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Clinical Update Submission
You may choose to view Group- or Facility-submittedWeb authorizations.
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Clinical Update Submission
Provide contact information and phone number.
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Clinical Update Submission
Click the “Note Type” drop-down box under “Service Information”to select the type of request being submitted.
Note: For a DRG facility, choices for “Note Type”will be “DRG Conversion Request” or “DRG Threshold Update.”
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Clinical Update Submission
Select number of days requested. * Required Field
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Clinical Update Submission
Provide clinical information in the Clinical Notes box and “Submit.”
It’s very important to date the
clinical information.
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Clinical Update Submission
Print the confirmation page for your records.
Click “Return” to submit another clinical update submission.
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Questions?