Important Update Regarding Preauthorizations We know many of you are actively attending training and reviewing current workflows in preparation for our upcoming preauthorization requirements. Our partnership with eviCore is progressing as expected, and we’re looking forward to improved turnaround times for our members and providers.
Starting March 1, 2017, you should submit preauthorization requests for durable medical equipment (DME), home health, and home oxygen through Clear Coverage instead of through our preauthorization forms on Your Health Alliance for providers.
Starting March 1, 2017, we will partner with eviCore, a national specialty benefit management company that focuses on managing quality and use for better outcomes for our patients, providers, and Health Alliance. eviCore will manage some preauthorization services for our commercial and Medicare lines of business to help us address the needs of our expanding complex member populations.
2017 Preauthorization Changes and Clarifications In our October Newsletter, we notified you that hospitals need to notify us of any observation stays, effective January 1. These details clarify this requirement:
Medicare Advantage members sometimes request procedures that aren't covered, such as nail trimmings, from their provider’s office. Our providers were requesting members sign Advance Beneficiary Notice (ABN) letters or other waivers of liability, which have members attest that they'll be financially liable for these non-covered services. CMS does not allow use of these forms prior to the services being rendered for Medicare Advantage plans. As a result of this rule, providers were absorbing the cost of providing non-covered services.