New Electronic Provider Access Tool gives you access to other Blue plans’ provider portals

As we told you in the October Record, we’re preparing to launch a new tool Jan. 1, 2014, that will make it easier for you to conduct preservice reviews for the out-of-state members you treat.

The Electronic Provider Access Tool will give you access to other Blue plan provider portals to conduct electronic preservice reviews, including prenotification, precertification, preauthorization and prior approval. The tool is part of a Blue Cross and Blue Shield Association requirement, and it will also allow providers outside of Michigan access to BCBSM’s Provider Secured Services site for preservice reviews.

The availability of the tool next month will vary, depending on the capabilities of each out-of-state member’s Blue plan. Some plans may have fully implemented the tool’s capabilities by Jan. 1, 2014, others may only allow preservice review for certain services and others may not have implemented any electronic preservice review capabilities. Also, Blue Care Network will not launch the tool until later in 2014.

Following is a quick look at how to use the tool.

• Go to bcbsm.com/providers and log in.
• Select the Conduct Pre-Service Review for Out-of-Area Members (includes notification, pre-certification, pre-authorization and prior approval) menu option.
• Enter the alpha prefix from the member’s ID card. The alpha prefix is the first three alpha characters that precede the member’s ID number.
• You’ll be automatically routed to the home plan’s Electronic Provider Access landing page. This page will welcome you to the Blue plan portal and indicate that you have left BCBSM’s portal. The landing page will allow you to connect to the available electronic preservice review processes.

Because the screens and functionality of a plan’s preservice review processes vary widely, home plans may include instructional documents or e-learning tools on the landing page with instructions on how to conduct an electronic preservice review. The page will also include instructions for conducting preservice review for services that can’t be submitted electronically.

Determining whether precertification is required
You can determine whether precertification is required by the member’s home plan by sending a request through BlueExchangeSM or accessing the home plan’s precertification requirements pages by using the medical policy router.

For more details, see the October Record article. If you have any questions, please contact your provider consultant.