How to handle authorization requests for physical, occupational and speech therapy continuing into 2020

For members receiving physical, occupational or speech therapy in 2019 that needs to continue into 2020, here's some information on how to submit these authorization requests to eviCore healthcare^®:

• You may submit an authorization request for additional visits as early as 14 days prior to or as late as seven days after the requested start date.
• Waiver visits previously granted through Landmark Healthcare (six visits for Category B providers and three for Category C providers) no longer apply.
• Category B and C providers must submit clinical information with their requests; the requests will be subject to a medical necessity review.

As a reminder, eviCore manages the following therapy services for non-autism diagnoses:

• Physical and occupational therapy for Medicare Plus Blue^SM PPO, BCN HMO^SM (commercial) and BCN Advantage^SM members
• Speech therapy for BCN HMO (commercial) and BCN Advantage members

Additional information is available on the ereferrals.bcbsm.com website:

• On BCN's Outpatient PT, OT, ST page
• On the Blue Cross eviCore-Managed Procedures page. Look in the "For Medicare Care Plus Blue PPO members" section.

Posted: December 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network