Beginning on January 1, 2019, there will be two changes for General Motors, Fiat Chrysler Automobiles (FCA), Delphi, and Aptiv PPO members living in Indiana, Ohio, and Kentucky.

 

Claims processing changes

 

The claims processing system for these members will be changing. As part of this change the benefits for these members will be administered directly by Blue Cross Blue Shield of Michigan, rather than from Anthem. This means that the utilization review program will be administered through Blue Cross Blue Shield of Michigan, who uses the services of AIM Specialty Health. The submission process for utilization review requests will be the same, through the AIM Portal, but will follow the program design for Blue Cross Blue Shield of Michigan. 

 

Prior authorization changes

 

Of particular note, Blue Cross Blue Shield of Michigan will require prior authorization for in-lab sleep testing by instate providers. Preapproval must be obtained for the following procedure codes:

  • 95805
  • 95807
  • 95808
  • 95810
  • 95811

 

The procedure codes will require preauthorization for both office settings and hospital outpatient locations.

 

All authorized attended sleep study services should be performed at a laboratory or center accredited by the American Academy of Sleep Medicine or the Joint Commission.

 

All providers performing sleep study services for our members must be certified in sleep medicine by a board recognized by Anthem.



Featured In:
December 2018 Anthem Ohio Provider Newsletter