Excellus BCBS Prior Authorization Process for Providers and Members

Excellus BCBS requires prior authorization for certain medical services and procedures to ensure they're medically necessary and meet specific guidelines.

To initiate the prior authorization process, providers must submit a request through the Excellus BCBS website or by contacting the Prior Authorization department directly.

The request must include detailed information about the patient, the proposed treatment, and the expected outcomes.

This information helps Excellus BCBS assess the medical necessity of the treatment and make a decision on coverage.

The prior authorization process for Excellus BCBS involves handling it digitally, which is a departure from the traditional in-office working conditions. This shift to online completion of documents is becoming increasingly common.

To initiate the process, you'll need to contact the Excellus prior authorization phone number, which is a key step in getting started. The phone number is a convenient option for those who prefer to communicate over the phone.

Once you've made contact, you can expect the process to unfold in a way that's distinct from its physical counterpart, as mentioned in the article.

The prior authorization process has undergone a significant shift, and it's now more common to complete documents online.

In today's digital age, even phone numbers like the Excellus prior authorization phone number aren't exempt from this change.

Handling prior authorization requests digitally differs from doing so in the physical world, which is a notable adjustment for many people.

This change has made it easier for people to access and use services like prior authorization, but it also requires some getting used to.

Step Therapy is a process that requires you to try a specific medication or treatment before your insurance will cover a different one. This can help ensure that you're getting the best treatment for your condition.

Medicare Part D and Dual Special Needs Plan (D-SNP) have specific Step Therapy policies that outline which medications require this process. You can find the 2024 and 2025 policies for Medicare Part D and D-SNP on the insurer's website.

To check if Step Therapy applies to your medication, search one of the insurer's online drug lists. If your medication is listed, you'll know that Step Therapy is required.

There are exceptions to Step Therapy, and your healthcare provider can request an exception if they believe it's necessary for your care. They'll need to submit a request supporting your need, and you can access the forms on the insurer's website.

Here are some specific policies to be aware of:

In Excellus BCBS, prior authorization is a requirement for certain services and medications to ensure they meet specific medical necessity standards.

Excellus BCBS has a list of services that require prior authorization, which can be found on their website or by contacting their customer service.

You must submit a prior authorization request at least 7-10 business days before the proposed service date to ensure timely review and approval.

Excellus BCBS uses a standardized process for reviewing prior authorization requests, which includes evaluating medical necessity, alternative treatments, and other factors.

If a request is denied, you can appeal the decision in writing within 60 days of the denial letter.

Excellus BCBS has specific requirements for submitting prior authorization requests, including providing detailed medical records and supporting documentation.

Electronic Authorization makes it easier to get the care you need. Excellus BCBS offers an eSignature for Authorization Lookup Tool, which allows you to electronically sign and return authorization requests.

This tool is convenient because it eliminates the need for printing, signing, and mailing paper documents.

Out-of-area BlueCard members are responsible for obtaining prior authorization/pre-certification from their BCBS Plan, but most providers choose to handle this obligation on the member's behalf.

Providers should request information on prior authorization and precertification, care management/utilization management, and concurrent review when verifying member eligibility and benefits, especially for inpatient or outpatient services.

If prior authorization/pre-certification isn't obtained for in-network, inpatient services, the provider will receive a financial sanction on the claim.

To file ancillary claims, you'll want to know which types of providers require prior authorization. Independent Clinical Laboratory, Durable/Home Medical Equipment and Supplies, and Specialty Pharmacy providers all fall under this category.

If you contract with multiple Excellus BCBS plans in the same state for the same product type, you can file the claim with either plan.

You can contact Excellus BCBS for prior authorization by faxing your request to their number, but unfortunately, that number is not provided in the article section facts.

To get a response to your prior authorization request within 24 hours, you can submit your request to DHCS, which is in partnership with Magellan, and they'll review it promptly.

If you're a Medi-Cal provider, you can submit your prior authorization request via fax to 1-800-869-4325, and use the preferred Medi-Cal Rx Prior Authorization Request Form or one of the approved forms like 50-1, 50-2, or 61-211.

The Medi-Cal Claim Form for Beneficiary Reimbursement must be filled out in blue or black ink and have an original signature, and it should include a photo copy of your Medi-Cal Beneficiary Identification Card (BIC).

You can also refer to the following table for contact and billing information: