Aug 1, 2022 • State & Federal / Medicaid

Effective November 1, 2022, prior authorization (PA) requirements will change for multiple codes. The medical code listed below will require PA by Empire BlueCross BlueShield HealthPlus. Federal and state law, as well as state contract language, and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

PA requirements will be added to the following:

  • L6026: Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device


To request a PA, you may use one of the following methods:

  • Availity:* Once logged in to Availity at https://www.availity.com, select Patient Registration > Authorizations & Referrals, then select Authorizations or Auth/Referral Inquiry, as appropriate.
  • Fax: 800-964-3627
  • Phone: 800-450-8753

 

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers on the provider website at https://providerpublic.empireblue.com. Contracted and noncontracted providers who are unable to access Availity may call our Provider Services at 800-450-8753 for assistance with PA requirements.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield HealthPlus.

 

NYE-NU-0426-22 July 2022

UM AROW 2892


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August 2022 Newsletter