FLASH: Utilization Management Practices Back in Place June 1
June 1, 2020As our communities dealt with the first weeks and months of the COVID-19 pandemic, we took multiple steps to remove authorizations for care to ensure expedient healthcare services were available for members and to ease the administrative burden on providers during the early part of the crisis. We hope our efforts have helped during these challenging times.
As of today, June 1, 2020, some of our regular utilization management practices are back in place.
As you may recall, from February 1 through May 31, we extended the length of many authorizations. Specifically, we updated all Outpatient procedures, Outpatient referrals, DME and any authorizations submitted to eviCore to an extended approval window of 180 days. The length of such authorizations submitted June 1, 2020 and after will return to the regular approval window of 90 days.
Also effective today, we will resume our regular approval process, for our Medicare Advantage members, for Positive-Airway-Pressure (PAP) and Oxygen delivery devices and supplies that include but are not limited to:
- NCD 240.2 Home Oxygen
- NCD 240.4 Continuous Positive Airway Pressure for Obstructive Sleep Apnea
- LCD L33800 Respiratory Assist Devices (ventilators for home use)
- NCD 240.5 Intrapulmonary Percussive Ventilator
- LCD L33797 Oxygen and Oxygen Equipment (for home use)
- NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management
- NCD 280.14 Infusion Pumps
- LCD L33794 External Infusion Pumps
Finally, starting today, we will begin clinical concurrent reviews in the acute Inpatient setting once again. In addition to providing us notification of admission, transfer and discharge, please resume your responses to our requests for clinical information and support of the Inpatient stay.
If you have any questions, please contact your Provider Network Management representative. We also invite our provider network to visit our COVID-19 webpage for up-to-date information about the illness, our response and questions about coverage. As always, we express our continued gratitude for your hard work, dedication and care for our members and the communities we serve.