Blue Cross and Blue Shield of Minnesota Implementation Resources

EviCore healthcare is pleased to provide prior authorization services for Blue Cross and Blue Shield of Minnesota (Blue Cross).

Commercial Members with dates of service August 1, 2018 and beyond will require prior authorization for the following services: Radiology, Cardiology, Sleep, Medical Oncology, Radiation Therapy, Molecular Lab and Musculoskeletal.

Medicare Advantage Members with dates of services January 1, 2019 and beyond will require prior authorization for the following services: Radiology, Cardiology, Sleep, Medical Oncology, Radiation Oncology, Molecular Lab, Musculoskeletal, Post-Acute Care, and Durable Medical Equipment.

Online Authorization tool for Blue Cross and Blue Shield of Minnesota members

Blue Cross now accepts Preadmission Notifications (PANs), precertification requests (Admission to Skilled Nursing Facility, Acute Rehabilitation, Long Term Acute Care, Residential Treatment, any admission for a Federal Employee), and prior authorization (PA) requests online at Availity.com.

This new capability supports the Blue Cross roadmap to further enable electronic submissions, improve provider efficiency and ability to self-serve. Your providers can access this tool from your local provider portal and get routed to this tool through the EPA router. As providers use the standard Electronic Provider Access flow, they will be connecting to Blue Cross’s new PA Portal developed to streamline the Prior Authorization process.

In your Plan’s portal, providers can click on your medical policy and pre-cert router and enter the alpha prefix associated with the group to be routed to this new tool. They can also can learn how to submit, find and update an authorization in the Blue Cross Prior Authorization – Training Demo once they are routed through the EPA router.

September 2019 Blue Cross® and Blue Shield® of Minnesota and EviCore Sleep/DME Program Update for Medicare Advantage Members

*** Attention Durable Medical Equipment (DME) & Sleep Management Suppliers ***

In an effort to improve process alignment and provider communications, EviCore has combined the management of both DME and Sleep Management programs within the same leadership structure.

This change is internal to EviCore and will not impact the prior authorization submission processes. Providers will continue the current processes of submitting prior authorizations for both DME and Sleep Management programs. If you have questions regarding the management of these programs, please email PAC Provider Engagement @ PAC.Engagement@evicore.com