Update September 1: After additional analysis, Blue Cross and Blue Shield of North Carolina has determined prior authorization for E0486 Oral Device/Appliance use for sleep apnea will not be required. Notification for E0486 has been removed from the Prior Plan Approval (PPA) grid. As a reminder, you can view the full medical policy for Sleep Apnea.

Effective October 1, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is adding E0486 “Oral device/appliance used to reduce upper airway collapsibility, adjustable, or nonadjustable, custom fabricated includes fitting and adjustment” to the Prior Plan Approval (PPA) grid.

Blue Cross NC is utilizing the Care Affiliate application within the Blue e portal to manage PPA authorization. View the full Care Affiliate Prior Plan Approval list.

To request prior plan approval, you can submit a prior authorization request through Care Affiliate online or by phone.

Online

To request online log into Blue e with your login and select “Health Management” from the left panel or “Authorization Requests or Status” from the middle section.

Watch our video for a walkthrough of the process of working with authorizations in Care Affiliate. In addition, you can access the video through the Blue e portal directly:

• Select View Archived Posts
• Select Care Affiliate Enhancements September 2022
• Click on link
• Working with Authorizations in Care Affiliate (brainshark.com)

Additionally, providers can request Care Affiliate training through Blue Cross NC’s Utilization Management Provider Support Team. The individual training sessions include information on the use of Care Affiliate, the different features available through Care Affiliate and how to correctly enter authorization requests.

To register for training, please email: electronicauthorizationsupportteam@bcbsnc.com

By phone

Call Care Affiliate toll-free at 800-672-7897 to reach the Authorization Intake Department.

Hours: Monday – Friday, 8 AM to 5 PM  (ET)

For assistance with Care Affiliate, call 888-333-8594.

 If you have other colleagues in your practice who will be submitting prior authorization requests, we encourage you to share this notice with them.

E0486 is generally not covered through dental plans but generally covered through medical plans such as: State Health Plan (SHP), Administrative Services Only (ASO) FEP, Fully Insured, IPP Host and IPP Home Claims. View the full medical policy for Sleep Apnea.