I know for MSHO clients they don't need prior auth but straight MC Advantage plans have been requiring them.  

And for MA BCBS I have been doing prior auths for all non MSHO plans after they used their "no auth 20 visits".   I am bad at keeping track.  It's a tricky thing not to bill the 21st visit before you have authorization so you won't have to appeal.  I have been trying to guess and put the end date in the software so the 21st visit and on will error out because I don't have it in EPIC as being authorized.   

Terisa Vig
Patient Account Representative
RiverView Health Home Care
tvig@riverviewhealth.org
218-281-9240
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Mary Hanson <mhanson@rvhci.com>
Sent: Wednesday, September 7, 2022 4:04 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] BCBS Medicare payer ID 00720
 

Hello!

 

Is anyone finding that BCBS MN Medicare episodes for payer ID 00720 are requiring prior authorization?  We had a couple of clients that we successfully billed and were paid for without prior authorization but now claims have started being denied saying “precertification/authorization/notification absent”.  For some clients the requirements changed during the middle of their episode.

 

Along those same lines any help on how/where to submit an appeal to them?

 

Thank you!

 

Mary Hanson | Billing Specialist | River Valley Home Care Inc.

916 8th Street Farmington, MN 55024

Phone: 651-460-4201

Email: mhanson@rvhci.com

 

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