CommercialNovember 30, 2018
Important information about utilization management
You can also request a free copy of our UM criteria from our medical management department, and providers may discuss a UM denial decision with a physician reviewer by calling us at the toll-free numbers listed below. UM criteria are also available on the web. Just select “Medical Policies, Clinical UM Guidelines, and Pre-Cert Requirements” from the bcbsga.com/provider website.
We work with providers to answer questions about the utilization management process and the authorization of care. Here’s how the process works:
- Call us toll free from 8:30 a.m.–5:00 p.m. Monday through Friday (except on holidays). More hours may be available in your area. Federal Employee Program hours are 8:00 a.m.–7:00 p.m.
- If you call after normal business hours, you can leave a private message with your contact information. Our staff will return your call on the next business day. Calls received after midnight will be returned the same business day.
- Our associates will contact you about your UM inquiries during business hours, unless otherwise agreed upon.
The following phone lines are for physicians and their staffs. Members should call the customer service number on their health plan ID card.
To discuss UM Process and Authorizations |
To Discuss Peer-to-Peer UM Denials w/Physicians |
To Request UM Criteria |
800 662-9023, 800 722-6614, 855-343-4851 or
Transplant:
Behavioral Health:
Autism: 844-269-0538
University System of Georgia (USG):
Behavioral Health:
State Health Benefit (SHBP) Behavioral Health: 855-679-5725
FAX 800-732-8318 (UM) FAX 877-606-3807 (ABD) |
877-771-9165
877-771-9165
Behavioral Health:
State Health Benefit (SHBP) Behavioral Health: 855-679-5725
State Health Benefit (SHBP) Medical:
FEP:
|
800-662-9023, 800-722-6614, 855-343-4851 or
Behavioral Health:
State Health Benefit (SHBP) Behavioral Health: 855-679-5725
State Health Benefit (SHBP) Medical:
FEP: FAX 800-732-8318 (UM) FAX 877-606-3807 (ABD) |
TDD/TTY |
711 Or TTY: 800-255-0056 Voice: 800-255-0135 |
For language assistance, members can simply call the Customer Service phone number on the back of their ID card and a representative will be able to assist them.
Our utilization management associates identify themselves to all callers by first name, title and our company name when making or returning calls. They can inform you about specific utilization management requirements, operational review procedures, and discuss utilization management decisions with you.
PUBLICATIONS: December 2018 BCBSGa Provider Newsletter
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