Web Authorization Submission

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.BlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association,

An Association of Independent BlueCross and BlueShield Plans. CPT® is a registered trademark of the American Medical Association

This document has been classified as public information.

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Authorization Submission

Enter user ID and password to log in to the secure area of bcbst.com.

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Authorization Submission

Select “Commercial/BlueAdvantage/BlueCare/TennCareSelect to begin the authorization submission process.

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Authorization Submission

All Web functions can be accessed through the left-hand menu.

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Authorization Submission

Select “Patient Inquiry” to view benefits, claims and other coverage.

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Authorization Submission

All authorizations are initiated under “Authorization/Advance Determination Submission.”

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Authorization Submission

Authorizations for inpatient confinement, 23-hour observation, outpatient procedures, specialty pharmacy, global obstetrics, and clinical updates

can be submitted online.

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Authorization Submission

Select the appropriate authorization to begin the authorization process.

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Authorization Submission

Enter the requested admit date in MM/DD/YYYY format, then select a member by entering the appropriate member ID number

without the three-letter prefix, then select “Search.”

The yellow dot indicates the stage of the process.

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Authorization Submission

Highlight correct member and click.

Member information will auto-populate

into the correct fields.

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Authorization Submission

Enter Provider, Facility and Confinement Information.

(Note: the yellow dot has progressed to the next stage)

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Authorization Submission

Enter Provider and Facility ID numbers if known.

“Search” for Provider and Facility ID numbers if not known.

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Authorization Submission

Search for Providers by entering ID, name

or location, then clicking “Search.”

A list of possible matches will becreated. Click the correct providerto auto-populate the authorization request.

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Authorization Submission

Reminder: •All fields with an asterisk must be completed. •ICD-9 codes should omit decimals.•Dates are in MM/DD/YYYY format.

Emergency admits can be backdated four days.

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Authorization Submission

Select the appropriate options from drop-down menus.

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Authorization Submission

Procedure codes are only needed for elective surgery authorizations.

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Authorization Submission

Milliman Care Guidelines criteria are selected by default and are necessary to obtain immediate online authorization.

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Authorization Submission

Note any pertinent member co-morbidities/history in the text field. This note field can also be used to list secondary physicians,

diagnosis or procedure codes.

If Milliman Care criteria are not applied, supporting information is required here and the authorization request will be pended for review.

When this screen is complete, choose “Continue.”

•This field is required when option was chosen to skip

Milliman Criteria and pend to BCBST nurse for review.

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Authorization Submission

When the screen is completed, a summary screen will be shown.Please review the information for accuracy and provider network status.

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Authorization Submission

If changes are needed, click “Back” to go back and correct the information. When all information is correct, click “Continue.”

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Authorization Submission

Apply Milliman Criteria

The system will show the most appropriate guidelines, based on diagnosis or procedure codes entered. If one is appropriate, click the box next to

it and select “Continue.”

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Authorization Submission

Apply Milliman Criteria

You may also find guidelines by selecting “Show All Guidelines”and “Search Guidelines.”

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Authorization Submission

Click “Show All Guidelines” to bring up a drill-down menu. Click “+” to drill down to the appropriate condition, then select the guideline.

Authorization Submission

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This example is being searched by description. Select “Search” after entering code or description.

The “Search Guidelines” option will bring up a search screen and can be searched by ICD-9, CPT® Code or guideline description.

Authorization Submission

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Authorization Submission

The Search screen will bring up the guidelines most closely associatedwith your search criteria.

Select the appropriate guideline and click “Continue.”

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Authorization Submission

Select all that apply, then click

“Continue.”

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Authorization Submission

A summary screen will show selected criteria.

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Authorization Submission

If the clinical information submitted meets the criteria, an authorizationnumber will be given. Print this page for your records.

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Authorization Submission

If the guideline is determined to be more suited for 23-hour observation, the user can either accept the observation or request pending status for

further medical review.

If the physician is a Gold Card provider, the Gold Card option will be offered here.

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Authorization Submission

If you choose to pend the authorization for further medical review, a screenwill be generated to allow you to submit additional clinical information.

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Authorization Submission

Notes are required when the authorization is pended for further medical review. When notes are complete, choose “Finish.”

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Authorization Submission

Authorizations that pend will generate a confirmation number. The confirmation number may be used to check status of the request

online. A nurse will call with the decision.

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Questions?

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Authorization SubmissionClinical Update Submission

Select “Clinical Update” to update initial authorizations submitted on the Web.

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Clinical Update Submission

Use the Quick Locator to key in the confirmation or reference number and click “Go,” or double click the correct confirmation number.

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Clinical Update Submission

You may choose to view Group- or Facility-submittedWeb authorizations.

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Clinical Update Submission

Provide contact information and phone number.

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Clinical Update Submission

Click the “Note Type” drop-down box under “Service Information”to select the type of request being submitted.

Note: For a DRG facility, choices for “Note Type”will be “DRG Conversion Request” or “DRG Threshold Update.”

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Clinical Update Submission

Select number of days requested. * Required Field

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Clinical Update Submission

Provide clinical information in the Clinical Notes box and “Submit.”

It’s very important to date the

clinical information.

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Clinical Update Submission

Print the confirmation page for your records.

Click “Return” to submit another clinical update submission.

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Questions?