Providers responsible for obtaining preservice reviews for out-of-area Blues members before inpatient admissions

As part of a Blue Cross and Blue Shield Association mandate, participating providers must perform preservice reviews for inpatient facility services provided to out-of-area Blues members when it’s required by the member’s plan. The change is effective July 1, 2014.

Keep the following guidelines in mind:

• Obtain preservice reviews prior to admission for inpatient facility services when such a review is required under the member’s plan.
• Out-of-area Blues members will not be held financially responsible for inpatient facility services provided if a preservice review is required and not performed prior to admission.
• Specified timeframes for preservice review may apply. These include: 48 hours to notify the home plan of a change in the preservice review and 72 hours in the case of an emergency or urgent care notification.

Providers can use the Electronic Provider Access tool to determine whether a preservice review is required. You can access the tool by going to bcbsm.com/providers and logging in. For complete details, see the article in the October Record.