Important precertification updates for 2021
Although our COVID-19 preservice review waivers remain in place until further notice, we want to share some other precertification updates for 2021.
eviCore program now includes State of Arizona employer group members
For 2021, both of the State of Arizona group benefit plans (member ID prefixes SYD and S3Z) are included in our eviCore program. The group continues to use a customized precertification requirements list that is very similar to our Blue Cross® Blue Shield® of Arizona (BCBSAZ) standard list and includes the eviCore specialty services and medications.
More code lists available for 2021!
We expanded our code list spreadsheet to include the customized requirements for the following employer groups:
- City of Phoenix – group numbers 040000 and 040004 (member ID prefix PXO)
- Snell & Wilmer – group number 030313 (member ID prefixes SWB, SNK)
- State of Arizona – group number 030855 (member ID prefixes SYD, S3Z) NOTE: List updated 01/12/21
- Teamsters – group numbers 031843 and 031844 (member ID prefix TYW)
In addition to the tab displaying the standard code list (applies to member ID prefixes XBB, XBM, XBP, Z3J, Z4E, Z4M, Z4P, Z4X, Z8M, Z5M, XBN, PMA, XBC, XBD, XBK, and XBO), you will see a tab for each of the above customized lists. You can also use the precertification lookup tool to check specific codes using the group number on the member ID card.
Compiled summary lists
We have removed the above-mentioned standard and customized lists from the precert summary lists PDF. For 2021, this reference document includes precertification requirements summaries only for:
- PCP Coordinated Care HMO plans
- Federal Employee Program® (FEP®) plans
- BCBSAZ-TPA co-administered plans:
- Amkor Technology, Inc. – group number 039176 (member ID prefixes K8Y, K8Z)
- Northwest Arizona Employee Benefit Trust (NAEBT) – group number 03746 (member ID prefix NBT)
- OB Sports Golf Management, LLC – group number 038043 (member ID prefix OBT)
Access precertification resources online
You can find the expanded code lists and the revised compiled summary lists in the secure provider portal at azblue.com/providers, along with other precertification resources in the Practice Management menu:
Updates for Medicare Advantage prior authorization
We updated the Medicare Advantage (MA) prior authorization form to add Arizona Priority Care (AZPC). You can download the form, the MA prior authorization code lists, and other helpful resources from the secure MA provider portal at “azbluemedicare.com/login > Prior Authorization.”
Here is the 2021 prior authorization request overview from Section 7 of the MA Provider Operating Guide:
For more information about these updates, please contact your provider liaison or call Provider Partnerships at 602-864-4231 or 1-800-232-2345, ext. 4231.
eviCore healthcare® is a separate, independent company that provides utilization management services to BCBSAZ providers and members. eviCore healthcare is a registered service mark of CareCore National, LLC.
Arizona Priority Care is a separate, independent company contracted with BCBSAZ to provide healthcare services to BCBSAZ providers and members. Arizona Priority Care is a service mark of Arizona Health Advantage, Inc.
P3 Health Partners is a separate, independent company that provides services to BCBSAZ providers and members.