Posted in Training, Updates

UHC Oxford- updated Prior Auth changes 01/01/2023

Starting 01/01/2023 Oxford will add and remove certain codes that require prior authorizations (commercial line of business).

According the Oxford this change helps align their processes with evidence-based clinical guidelines.

Some of the new codes that will be added are:

For a full list of new codes that will be added to the list of codes that require prior authorization, please click here.

In addition Oxford is also adding a new provider tool, the UnitedHealthcare Oxford plan Prior Authorization Requirements document, it will become available as of Dec. 1, 2022, on the Advance Notification and Clinical Submission Requirements page.

Providers are encouraged to use this tool where they will be able to find/research codes that require prior authorization as well as request an auth.

Would you like to learn more: please click here, for the Applicable Oxford Commercial policies.

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Posted in BCBS (Various States), Training

BCBS of Minnesota: Medical and Pharmacy benefit updated 09/05/2022

The following prior authorization changes apply to BCBS of Minnesota Commercial and/or Medical Advantage Plan types.

The changes will take affect on 09/05/2022 and for all of the DOS thereafter.

If you are physician that provides above mentioned services to the BCBS of MN members of commercial and/or medicare advantage plans and you have questions,
please contact provider services at (651) 662-5200 or 1-800-262-0820.

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Posted in #Medicare, #Medicareadvantage, BCBS (Various States), Training, Updates

BCBS California: Authorizations for post-acute care services (Medicare Advantage Plans/GRS)

The following blog will discuss where and how the providers should submit their prior authorizations for post-acute care services for Medicare Advantage Individual, Group Retiree Solutions, and Dual Eligible Plan members.

Note: Dual Eligible- member qualifies for Medicaid and Madicare.

This change is applied for services rendered on Sept 1, 2022 and thereafter. The services included are: admission to or concurrent* stay in a skilled nursing facility (SNF), an inpatient acute rehab facility (IRF), or a long-term acute care hospital (LTACH).

These services will be reviewed by myNEXUS.**

*Concurrent stay review requests for members admitted to SNF, IRF, or LTACH facilities prior to September 1, 2022, should be directed to the health plan.

** myNEXUS is an independent company providing post-acute benefits management services on behalf of Anthem Blue Cross.

How to submit or check a prior authorization request

For SNF, IRF, or LTACH admissions, myNEXUS will begin receiving requests on Tuesday, August 30, 2022, for members whose anticipated discharge date is September 1, 2022, or after.

Providers can send their request online- Go to to get started. You can upload clinical information and check the status of your requests through this online tool seven days a week, 24 hours a day.

If you are unable to use the link or website, you can call the myNEXUS Provider Call Center at 844-411-9622 during normal operating hours from 7 a.m. to 7 p.m. CT, Monday through Friday, or send a fax to myNEXUS at 1-833-311-2986.

Note: myNexus does not review requests for DME, Ambulance- These services do not fall under the Medicare Home-health services: infusion, hospice, outpatient therapy, or supplemental benefits that help with everyday health and living such as personal home helper services offered under Essential/Everyday Extras.

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