Authorization process update for identified HCBS procedure codes

Anthem Blue Cross and Blue Shield (Anthem) is modifying the authorization process for the following home- and community-based services (HCBS) procedure code: Personal Care Services — T1019.

 

The above service will be authorized by Anthem for up to a year at a time, broken down into monthly units (January, February, March, etc.). This change will not allow unused units from a previous month to be provided and paid without prior authorization approval.

 

No additional services will be affected by these changes at this time. 

 

Authorizing services with monthly units will:

• Allow easier matching of claims to authorizations.
• Allow case managers to more efficiently track utilized services from month to month, identify gaps in care and more easily make revisions when a member has a change in condition that necessitates service changes.
• Reduce authorization impact when service needs change. Authorizations can be revised for the impacted months only.
• Affect only authorizations for members whose annual service plan is due beginning January 1, 2020. 

 

These changes will not:

• Affect how a provider currently requests or bills for services.
• Impact authorizations for members whose annual service plan is not due.

 

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 1-855-558-1443.