Authorization requirements are changing for home health, TPN and IDPN services for BCN members
Authorization requirements are changing for home health, total parenteral nutrition and intradialytic parenteral nutrition services for Blue Care Network members.
Here's what's changing.
Home health services
For traditional home health care, including services such as nursing visits and physical, occupational and speech therapy, the following changes are occurring:
- For BCN HMOSM (commercial) and BCN AdvantageSM members covered through the UAW Retiree Medical Benefits Trust, home health no longer requires authorization. This was effective in December 2019 and applies to both contracted and noncontracted providers.
- For BCN HMO and BCN Advantage members not covered through the UAW Retiree Medical Benefits Trust, home health requires authorization for these providers:
- Noncontracted providers. Call these authorization requests in to BCN Utilization Management at 1-800-392-2512.
- Providers who are contracted with BCN but who do not belong to the provider network associated with the member's plan. Submit these authorization requests through the e-referral system.
TPN and IDPN services
TPN and IDPN services won't require authorization for BCN members starting Feb. 3, 2020. This applies to both contracted and noncontracted home infusion providers and to all BCN HMO and BCN Advantage members.
Additional information
In February 2020, we'll update the Care Management chapter of the BCN Provider Manual to reflect the changes related to home health, TPN and IDPN. Look in the section titled "Guidelines for transitional care."
We'll also remove the Home care form and the TPN Nutrition Assessment / Follow-up Form from our ereferrals.bcbsm.com website.
These changes don't affect enteral nutrition services, which continue to require authorization. Submit authorization requests for enteral nutrition through the e-referral system and complete the questionnaire that opens.
Posted: January 2020
Line of business: Blue Care Network