Overview
This article houses some of our most frequently asked questions and their answers for BlueCross BlueShield of Tennessee specifically.
How do I submit a prior authorization request?
Please view the following demo video for a tutorial on how to submit a prior authorization request through Cohere for patients with BlueCross BlueShield of Tennessee.
How can I check the status of a prior authorization request submitted through Cohere?
To check the status of your authorization request, navigate to the dashboard from the request details page, where you will be dropped when you SSO onto the Cohere portal. To do this, click the "cancel" button, found at the bottom right side of the screen. This will redirect you to the dashboard, where you can view the statuses of your requests. You can also navigate to the patient summary from the dashboard, where you can view additional demographic information about the patient, as well as other requests that have been submitted for them by your practice.
Do I need to go through the Availity SSO to Cohere flow to submit my authorization request to Cohere, even if I submit requests for other payers?
Yes. Please submit all requests for patients with BlueCross BlueShield of Tennessee through Availity→SSO to Cohere flow to submit your requests. This ensures that a proper member benefit check is completed prior to submitting your authorization request. Login to Cohere to simplify the process when entering authorizations for multiple payers.
I'm submitting a Medicare (BlueCare) retro-authorization. What do I need to know?
If you are submitting a Medicare (BlueCare) retro-authorization, you must indicate that it is being submitted for one of the following reasons:
The Enrollee did not provide BlueCare Tennessee insurance information
The Enrollee ID Card was not issued
Medicare was incorrectly documented as primary
There was a coverage issue
Failure to do so will result in your authorization request being admin voided.
What are some best practice submission tips for high tech imaging requests?
Introduction
When submitting prior authorization requests in the Cohere portal, these are some important things to keep in mind to ensure you get an approval for your patients as quickly as possible.
Download a PDF version of this article here.
Provider and Facility Details
When submitting a prior authorization request, you will need to indicate the place of service. Please be sure you are selecting the most appropriate option from this drop down list. For example, do not select a facility for a high tech imaging request if you are not sure there is an imaging machine at that facility.
Next, you need to fill in the provider and facility details. The provider and facility fields are searchable by NPI*, tax ID number (TIN), or name.
If the facility or provider you are searching for is missing, you are able to make changes directly within the Cohere portal.
*Note: In provider fields, only type 1 NPIs will be searchable. In facility fields, only type 2 NPIs will be searchable.
Expediting Requests
The expedite option is only appropriate when applying standard turnaround times could seriously jeopardize the either:
The life or health of the enrollee OR
The enrollee's ability to regain maximum function (e.g., loss of limb)
Please note that inappropriately expediting cases can lead to adverse outcomes. If you expedite a case that does not need to be expedited, cases that require expedited attention may be delayed, potentially impacting life-saving care for patients.
Helpful Tips for Expediting Requests
Ensure your request truly meets this guidance for expediting requests.
If the clinical documentation does not reflect the urgency of the request, it may be flagged for review and changed to standard.
Please ensure that all appropriate documentation is supplied with your initial submission.
Therapy and imaging requests do not typically meet the criteria for expedited processing.
Please avoid submitting an expedited request on a Friday or holiday weekend, as the 24 hour window applies to calendar days not business days.
View this article for more information on expedited requests.
Where can I find out which High Tech Imaging (HTI) codes I should submit through Cohere?
You can view the Prior Authorization List (PAL) codes under management for High Tech Imaging (HTI) prior authorizations here.
UM Tech
Where can I find out which UM Tech codes I should submit through Cohere?
You can view the prior authorization list (PAL) codes under management for UM Tech prior authorizations here.
Am I able to manually add provider details when submitting an emergent unplanned admission request for a member without OON benefits?
In order to manually add provider details for an emergent unplanned admission request for a member without OON benefits, you must select one of the specific authorization categories shown in the screenshots below.
If you select the following auth category, you will NOT be able to select a manually created provider.
Medical Care - Acute Inpatient, NICU I-IV, or Mental Health.
Can I edit my UM tech request?
BlueCross BlueShield of Tennessee does not allow editing after submission. The following edit box option may appear on an approved auth when information is incomplete or mismatched.
Please note, attachments can be added to pending authorizations.