Blue Cross enhances tools for electronically prescribing medications and submitting prior authorizations

Blue Cross Blue Shield of Michigan is committed to enhancing its electronic processes across the health care spectrum, including the processes used by prescribers.

As part of our transition to OptumRx as our new pharmacy benefit manager, we’re making some improvements to our provider-facing tools to assist with prescribing and submitting prior authorizations electronically. These enhancements will primarily take place behind the scenes and won’t have a major effect on how providers prescribe and submit prior authorizations or check on patients’ benefits.

As we communicated in a September Record article, the move from Express Scripts, Inc. to OptumRx will take place Jan. 1, 2022, for commercial individual and group members, and Jan. 1, 2023, for Medicare Advantage individual and group members. 

Prescribers should continue to use their current electronic medical record system or CoverMyMeds^® to submit electronic prior authorizations for Blue Cross and Blue Care Network members. Keep in mind that the BIN number changes to 610011, effective Jan. 1, 2022, for all Blue Cross and BCN commercial members.

Electronic prior authorization, or ePA, replaces faxing and phone calls so prescribers can focus less on administrative tasks and more on patient care. For more information on ePA and CoverMyMeds, see our ePA flyer.

Also, continue to use electronic medical records for electronic prescribing and real-time prescription benefit checks. Note: You may have heard of a tool called PreCheck MyScript. This is an internal name that OptumRx uses for its real-time benefit check connectivity and programing with electronic medical record systems. From a provider perspective, the interface will look and feel much the same as what health care providers currently use with Express Scripts.

Once we launch Availity, our new secure provider portal, we’ll also provide a link to Prompt PA, another resource that can be used to submit electronic prior authorization requests for pharmacy benefit drugs.

By using these tools, physicians get patient-specific pharmacy information up front. And the better physicians and patients understand the medication options and costs at the point of prescribing, the more likely patients are to fill prescriptions and adhere to their medication regimen.

The Pharmacy team is communicating about these enhancements at various provider-facing forums, including regional medical director meetings, BCN business administrator meetings and network performance improvement meetings.

If you or your staff members have any questions, they can call the Pharmacy Help Desk at 1-800-437-3803.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.