Provider notification for utilization management authorization rule operations workgroup item 2662

On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Empire BlueCross BlueShield. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

Prior authorization requirements will be added for the following codes:

• K1022 — Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type

 

Not all PA requirements are listed here. PA requirements are available to contracted providers on the provider website at https://www.empireblue.com/medicareprovider > Login or by accessing Availity.* Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the member’s ID card.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield.

 

EBSCRNU-0218-22 January 2022