|
March 13, 2017 | View this notice online
Prior Auth Required From OrthoNet for Certain Major Joint and Foot/Lower Extremity Procedures
Blue Cross and Blue Shield of North Carolina (Blue Cross) utilizes the services of OrthoNet, LLC, to manage the prior authorization process for certain major joint and foot/lower extremity procedures for Blue Medicare HMO and Blue Medicare PPO members.
- Providers who participate in Blue Cross’ Medicare Advantage networks and specialize in major joint and foot/lower extremity procedures are required to contact OrthoNet for prior authorization of services for Blue Medicare HMO and Blue Medicare PPO members if the code is included on the OrthoNet Prior Authorization Major Joint and Foot/ Lower Extremity Code List.
- All non-emergency services included on the authorization code list require prior authorizations from OrthoNet, regardless of the level of care (i.e. outpatient/inpatient).
- Prior authorization must be obtained in advance of services provided to Blue Medicare HMO and Blue Medicare PPO members. Claims submitted for services which did not receive prior authorization by OrthoNet will be subject to claims denial.
We originally communicated delegation to OrthoNet of prior authorization for certain major joint and foot/lower extremities procedures on October 5, 2016, for services performed on or after January 1, 2017.
Details about OrthoNet and how you can request prior authorization for services are available in the Major Joint and Lower Extremity Services Overview and FAQs.
|