Utilization management authorization rule operations

On November 1, 2021, Empire BlueCross BlueShield (Empire) prior authorization (PA) requirements will change for L8702 covered by Empire. 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.

 

PA requirements will be added for the following code:

• L8702 — Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated

 

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers on the provider website at https://www.empireblue.com/provider/news/archives/?category=medicareadvantage&_ga=2.209275602.1765289005.1589318293-1890328679.1582138833 > Login or by accessing Availity.* Once logged in to Availity (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 our Provider Services at the number on the back of your patients’ Empire ID card for assistance with PA requirements.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield.
EBSCRNU-0181-21 July 2021

519233MUPENMUB