BLUECONNECT

Providers

April 2023

In This Issue

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Note of appreciation from Dr. Cara Christ

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April updates, reminders, and tips

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Preview May 2023 code edit updates

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Waiver extended for PCP referral approvals

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May 1: More drugs to require site-of-service review

Check out our current

member ID card samples

Update: Waiver of requirement for approval of PCP referrals (for PCP-HMO plans) has been extended until further notice

For now, Blue Cross^® Blue Shield^® of Arizona (BCBSAZ) is continuing the temporary waiver of the requirement that PCPs obtain approval for referrals for our PCP Coordinated Care HMO (PCP-HMO) plans. PCPs should continue to make in-network referrals for specialist office visits. We will let you know when we reinstate the requirement for BCBSAZ approval for such referrals.

More info about this waiver
Ordinarily, the member’s designated PCP must request BCBSAZ authorization for referrals to most specialists. These in-network referrals are still necessary. However, until further notice, these referrals do not need to be authorized by BCBSAZ. We have temporarily deactivated the referral request functionality on the secure provider portal.

Please note: All other coverage requirements (e.g., medical necessity and prior authorization) still apply.

Reminders about the 2023 PCP-HMO plans

1.	PCP-HMO plans now use the BCBSAZ standard prior authorization requirements.
2.	PCP-HMO plans are now included in our eviCore prior authorization program.
3.	Please check eligibility and benefits for the assigned PCP. The ID cards no longer display this information.

ID card samples:

Please share this information with your clinical and administrative support teams.

To learn more about our 2023 PCP-HMO plans, see the 2023 Provider Operating Guide, Section 8, and the PCP-HMO e-learning slides. If you have questions about the updates, contact your provider liaison or call us at 602-864-4231 or 1-800-232-2345, ext. 4231.

In This Issue

►

Note of appreciation from Dr. Cara Christ

►

April updates, reminders, and tips

►

Preview May 2023 code edit updates

►

Waiver extended for PCP referral approvals

►

May 1: More drugs to require site-of-service review

Check out our current

member ID card samples

Blue Cross, Blue Shield, the Cross and Shield Symbols, MyBlue, BlueCard, Federal Employee Program, and FEP are registered service marks, and BluePathway and BlueJourney are service marks, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

eviCore healthcare® is a separate, independent company contracted with BCBSAZ to provide utilization management services to BCBSAZ providers and members. eviCore healthcare is a registered service mark of CareCore National, LLC.

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