We’ve made changes to the noncovered services prior authorization process for Medicare Advantage members

Immediately: Billing team must stop submitting prior authorization requests for noncovered services through the e-referral system for Medicare Plus Blue and BCN Advantage members. When attempting to submit these requests, the system will reject them with a specific error message. Instead, submit voluntary organization determinations or advance coverage determinations directly to BCBSM or BCN. Before submitting, check CMS National/Local Coverage Determinations and Blue Cross medical policies using the Medicare Coverage Database and Medical Policy Router to confirm coverage status.