Web Authorization Submission BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the...

Web Authorization Submission

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.BlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association,

An Association of Independent BlueCross and BlueShield Plans. CPT® is a registered trademark of the American Medical Association

This document has been classified as public information.

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Authorization Submission

Enter user ID and password to log in to the secure area of bcbst.com.

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Select “Commercial/BlueAdvantage/BlueCare/TennCareSelect to begin the authorization submission process.

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All Web functions can be accessed through the left-hand menu.

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Select “Patient Inquiry” to view benefits, claims and other coverage.

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All authorizations are initiated under “Authorization/Advance Determination Submission.”

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Authorizations for inpatient confinement, 23-hour observation, outpatient procedures, specialty pharmacy, global obstetrics, and clinical updates

can be submitted online.

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Select the appropriate authorization to begin the authorization process.

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Enter the requested admit date in MM/DD/YYYY format, then select a member by entering the appropriate member ID number

without the three-letter prefix, then select “Search.”

The yellow dot indicates the stage of the process.

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Highlight correct member and click.

Member information will auto-populate

into the correct fields.

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Enter Provider, Facility and Confinement Information.

(Note: the yellow dot has progressed to the next stage)

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Enter Provider and Facility ID numbers if known.

“Search” for Provider and Facility ID numbers if not known.

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Search for Providers by entering ID, name

or location, then clicking “Search.”

A list of possible matches will becreated. Click the correct providerto auto-populate the authorization request.

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Reminder: •All fields with an asterisk must be completed. •ICD-9 codes should omit decimals.•Dates are in MM/DD/YYYY format.

Emergency admits can be backdated four days.

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Select the appropriate options from drop-down menus.

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Procedure codes are only needed for elective surgery authorizations.

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Milliman Care Guidelines criteria are selected by default and are necessary to obtain immediate online authorization.

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Note any pertinent member co-morbidities/history in the text field. This note field can also be used to list secondary physicians,

diagnosis or procedure codes.

If Milliman Care criteria are not applied, supporting information is required here and the authorization request will be pended for review.

When this screen is complete, choose “Continue.”

•This field is required when option was chosen to skip

Milliman Criteria and pend to BCBST nurse for review.

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When the screen is completed, a summary screen will be shown.Please review the information for accuracy and provider network status.

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If changes are needed, click “Back” to go back and correct the information. When all information is correct, click “Continue.”

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Apply Milliman Criteria

The system will show the most appropriate guidelines, based on diagnosis or procedure codes entered. If one is appropriate, click the box next to

it and select “Continue.”

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Apply Milliman Criteria

You may also find guidelines by selecting “Show All Guidelines”and “Search Guidelines.”

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Click “Show All Guidelines” to bring up a drill-down menu. Click “+” to drill down to the appropriate condition, then select the guideline.


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This example is being searched by description. Select “Search” after entering code or description.

The “Search Guidelines” option will bring up a search screen and can be searched by ICD-9, CPT® Code or guideline description.


Heather Schablik

deleted "by" before "guideline description."

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The Search screen will bring up the guidelines most closely associatedwith your search criteria.

Select the appropriate guideline and click “Continue.”

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Select all that apply, then click

“Continue.”

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A summary screen will show selected criteria.

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If the clinical information submitted meets the criteria, an authorizationnumber will be given. Print this page for your records.

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If the guideline is determined to be more suited for 23-hour observation, the user can either accept the observation or request pending status for

further medical review.

If the physician is a Gold Card provider, the Gold Card option will be offered here.

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If you choose to pend the authorization for further medical review, a screenwill be generated to allow you to submit additional clinical information.

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Notes are required when the authorization is pended for further medical review. When notes are complete, choose “Finish.”

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Authorizations that pend will generate a confirmation number. The confirmation number may be used to check status of the request

online. A nurse will call with the decision.

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Questions?

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Authorization SubmissionClinical Update Submission

Select “Clinical Update” to update initial authorizations submitted on the Web.

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Clinical Update Submission

Use the Quick Locator to key in the confirmation or reference number and click “Go,” or double click the correct confirmation number.

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You may choose to view Group- or Facility-submittedWeb authorizations.

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Provide contact information and phone number.

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Click the “Note Type” drop-down box under “Service Information”to select the type of request being submitted.

Note: For a DRG facility, choices for “Note Type”will be “DRG Conversion Request” or “DRG Threshold Update.”

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Select number of days requested. * Required Field

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Provide clinical information in the Clinical Notes box and “Submit.”

It’s very important to date the

clinical information.

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Print the confirmation page for your records.

Click “Return” to submit another clinical update submission.

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Questions?

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