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Update: Changes in prior authorization for Blue Cross NC outpatient therapy requests now effective December 1
November 01, 2024
Medical Policy & Clinical Guidelines Claims & Coding Products & Programs

Update November 1, 2024: On August 29, 2024, Blue Cross NC issued a provider notice announcing the transition of medical necessity review of outpatient therapy services for Commercial Fully Insured members to Carelon effective November 1, 2024.

Due to a technical issue identified on October 21 affecting providers’ access to the Carelon portal, the previously announced effective date for this program has been delayed one month. The new effective date is December 1, 2024.

 

Carelon Portal Access

Providers attempting to enter a request on the Carelon portal for the Rehabilitation Program may encounter one of the following scenarios:

1. The provider can submit their request with no issue (most providers should be in this category).

2. The provider enters their request and is directed to enter their demographic information. This information is required to move forward with the request.
Add demographic information on the "User Information" tab on the "User Profile" page in the Carelon portal. Add demographic information on the "User Information" tab on the "User Profile" page in the Carelon portal.

3. The provider enters their request and the below “Apologies” page appears once member information is entered and the “Rehabilitation” icon is selected.
The Carelon apologies error page may appear, letting you know the page could not be displayed. The Carelon apologies error page may appear, letting you know the page could not be displayed.

If you see the "Apologies" page after entering the member's information and selecting the "Rehabilitation" icon, you will need to follow these steps to fix the issue.


1. In the Carelon portal, select “Manage Your User Profile.”
In the Carelon portal, select "Manage Your User Profile" button. In the Carelon portal, select "Manage Your User Profile" button.

2. Select the “User Information" tab.
There are three tabs on the User Profile page. Select the “User Information" tab. There are three tabs on the User Profile page. Select the “User Information" tab.

3. Enter your information in the orange required fields and select "Save." 
Enter or update information in required fields, which are highlighted in orange. Then click the "Save" button. Enter or update information in required fields, which are highlighted in orange. Then click the "Save" button.

4. Select the “Home” icon to return to the home page and submit a request.

Providers who have already obtained an authorization extending beyond the December 1 effective date do not need to request a new authorization for dates that are included in the previously submitted request. However, any dates outside of that period or any new service codes not included in the original authorization will require a new request. Therapy prior authorization requests through Carelon cannot be submitted more than 30 days in advance of the requested service date.

We appreciate your patience as we work to ensure a successful launch of this program.

For questions, please contact the Provider Service line located on the back of the member’s identification card.

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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