Attention Institutional Providers: Effective July 1, Facilities Must Obtain Pre-Auth for Inpatient Services for All Blues Members
June 26, 2014 - Inpatient facilities must obtain pre-authorizations for certain inpatient services for out-of-area Blues members rendered on or after July 1, 2014. Physician offices are not responsible for obtaining authorizations for facility services.
What this means for your facility:
- If you do not obtain the authorization, a penalty (per the member’s contract) will be applied or the claim will be denied.
- You may not balance bill the member for services if an authorization was not obtained. The member is to be held harmless.
If you have any questions, call your Institutional Provider Representative: www.carefirst.com/providerrep.
Save Time, Pre-Auth Online
Prior authorizations for out-of-area and local members can be obtained online through our Provider Portal.
Visit www.carefirst.com/cpet to register for an upcoming Out-of-Area Notifications webinar to learn more.
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