The Prior Authorization Process is Changing. Are You Ready?

The Prior Authorization Process is Changing. Are You Ready?

September 13, 2024

On Nov. 15, 2024, BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan will be making changes to the prior authorization (PA) process. While you will still sign on through My Insurance ManagerSM, the portal will route you to a new web-based application, powered by Cohere Health, that will enhance the efficiency of PA decisions.

These latest changes will only impact the authorizations managed by BlueCross and BlueChoice®. The prior authorization process for our third-party vendors like Evolent, Avalon Healthcare Solutions, HealthHelp and Novologix will remain the same.
 

Benefits of the new process

  • Accelerates and expands real-time approvals.
  • Enables a more seamless provider experience.
  • Decreases administrative efforts.
  • Meets new CMS1 and NCQA2 requirements that shorten the time for PA decisions.
     

What the new process will do
 

  • Verify member eligibility.
  • Verify the provider’s network.
  • Check prior authorization requirements, including medical record requirements.
  • Verify procedure and diagnosis codes.
  • Expand fast-track approvals and real-time responses.
  • Align with our clinical policies.
  • Allow for digital submission of medical records.


What you need to do
To get ready, be sure to register with Cohere Health to access the new web-based application before the implementation date. If you already have an account with Cohere Health, you do not need to create a new one. You can continue logging in as usual.

There are also available webinars and a beneficial learning center that will help prepare you for the coming changes. We encourage you to review these resources at your earliest convenience.

Lastly, if you have any additional questions, feel free to reach out to your dedicated Provider Relations Consultant, and they will be glad to assist you.

 

1Centers for Medicare and Medicaid Services (CMS)
2National Committee for Quality Assurance (NCQA)
 

Evolent, Avalon Healthcare Solutions, HealthHelp and Novologix are independent companies that manage utilization management services on behalf of BlueCross and BlueChoice® HealthPlan.