I handle a high quantity of BCBS plans with Evicore and this is standard practice for Evicore to close the old auth and start a new auth on a Resumption. They do not require you to discharge and readmit the patient, but they do require a new auth.

The new Auth start date would be the Resumption date and they accept the Resumption documentation in place of the SOC medical records. Makes our clinical happy to not have to do that process and I am not having issues on the claim side.

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Anna Sanderson Billing Specialist Interim HealthCare of the Twin Cities 2680 Arthur St | Roseville MN 55113 +16512947979  |  .

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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Marnie Pogreba
Sent: Wednesday, July 5, 2023 10:37 AM
To: billers@list.mnhomecare.org
Subject: [EXTERNAL] RE: BCBS Advantage question

CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe.

Evicore, might close out your previous authorization due to the hospital stay.  We recently had this happen, I had to fax a request to Evicore with reference to the auth number we had and ask for an authorization resumption, and requested the amount of visits we would need.  Evicore sent us an entirely new authorization number.  Because there are now 2 authorizations numbers for the claim, I just noted the other auth # in the remarks. 

Marnie Pogreba Home Care and Hospice OFFICE: 218 894 8324 Fax: 218 894 8099 LAKEWOOD HEALTH SYSTEM, SENIOR CAMPUS 401 Prairie Ave NE| Staples, MN 56479

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Kelly Rader
Sent: Wednesday, July 05, 2023 10:26 AM
To: billers@list.mnhomecare.org
Subject: RE: BCBS Advantage question

**External Sender**

As long as the client was resumed prior to the next recertification cert period you should be fine and a new SOC should not be needed. 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hespe, Linda J
Sent: Wednesday, July 5, 2023 10:20 AM
To: billers@list.mnhomecare.org
Cc: Retz, Carol <Carol.Retz@EssentiaHealth.org>
Subject: BCBS Advantage question

Hello,  We are being told from our auth that a patient on a BCBS Advantage plan that was hospitalized and now home with a resumption of care needs to be discharge, then a whole new start of care and Auth must be done.  It doesn’t seem like we have had to do that to reauth with full admit before.  Does anyone know if this is true?

Linda Hespe RN, MBA

Director

Essentia Health Home Care and Hospice West

114 Frazee Street East   Detroit Lakes, MN 56501

P: 218-314-7806 F: 218-847-0850

Linda.Hespe@EssentiaHealth.org https://link.edgepilot.com/s/fd821f21/NIRMFVB2FES6-m4LiKcHoQ?u=http://www.essentiahealth.org/

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