Submitting Prior Authorizations is Getting Easier (Healthy Blue + Medicare (HMO D-SNP))

Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

Blue Cross NC is transitioning to the Availity Essentials Authorization application for Healthy Blue + Medicare (HMO D-SNP).

You may already be familiar with the Availity multi-payer Authorization app because thousands of providers are already using it for submitting prior authorizations for other payers. Blue Cross NC is eager to make it available to our Healthy Blue + Medicare providers, too. In September, you can begin using the same authorization app you use for other payers for Blue Cross NC.

If you need to refer to an authorization that was submitted through ICR, you will still have access to that information. We’ve developed a pathway to access your ICR dashboard. You will simply follow the prompts provided through the Availity Authorization app. To make it even more convenient, you can pin your authorizations from the ICR application to your Availity Authorization app dashboard.

While we grow the Availity Authorization app to provide you with Blue Cross NC-specific information, you will still need to access ICR for:

• Appeals
• Behavioral health authorizations and inquiries
• Federal Employee Program® authorizations and inquiries
• HealthLink authorizations and inquiries
• Medical specialty prescription authorizations and inquiries

Notices in the Availity Authorization app will guide you through the process for accessing ICR for alternate authorization and appeals functions.

If you aren’t already familiar with the Availity Authorization app, training is available. Visit the training site to enroll for an upcoming live webcast or to access an on-demand recording at the Availity Authorization training site.

Accessing the Availity Authorization app is easy. Ask your organization’s Availity administrator to ensure you have the Authorization role assignment. Without the role assignment, you will not be able to access the Authorization application. Then, just log onto Availity.com to access the app through the Patient Registration tab by selecting Authorizations and Referrals.

Note: Availity, LLC is an independent company providing administrative support services for Healthy Blue + Medicare providers on behalf of Blue Cross and Blue Shield of North Carolina. 

Healthy Blue + Medicare HMO D-SNP

Blue Cross and Blue Shield of North Carolina Senior Health, DBA Blue Cross and Blue Shield of North Carolina, is an HMO D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal.

NCBCBS-CR-030956-23-CPN29378 August 2023