Utilization management tool available on Availity Payer Spaces: Authorization Rules Lookup tool

In March 2021, we introduced our new Authorization Rules Lookup tool that you can access through Availity Payer Spaces. We encourage you to utilize this tool and discover how much this will improve the efficiency of your authorization process. 

 

This self-service application displays prior authorization rules so you can quickly verify if outpatient services require prior authorization for members enrolled in our commercial plans. In addition to verifying whether an outpatient authorization is needed, the tool provides the following details that apply to the procedure code:

• Medical policies and clinical guidelines
• Third party guidelines, if applicable (such as AIM Specialty Health, IngenioRx)

 

Access the Authorization Lookup application through Availity Payer Spaces:

1. Select Payer Spaces
2. Select Empire BlueCross BlueShield tile from the Payer Spaces menu
3. Select Applications tab
4. Select Authorization Rules Lookup tile

 

Once you are in the tool, you will need to provide the following information to display the service’s prior authorization rules:

• Tax ID
• National Provider Identifier (NPI)
• Member ID and birth date*
• Member’s group number or contract code*
• CPT/HCPCS code

 

*This information can be found on the member’s ID card or through the Eligibility & Benefits return on the Patient Information tab.

 

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