We remind you that the sleep management program will be managed directly through Excellus BlueCross BlueShield effective November 5, 2018. As you may know, currently, the sleep management program is being managed by an independent company, eviCore Healthcare, on behalf of the Health Plan. We notified you of this upcoming change in our bulletin issued September 20, 2018.
Effective November 5, 2018, preauthorization for laboratory diagnostic sleep studies, PAP equipment and submission for PAP compliance monitoring must be requested through the Clear CoverageTM online preauthorization tool. Exception: If the initial PAP equipment preauthorization was previously obtained through eviCore, documentation regarding compliance and improvement should be faxed to the Health Plan at 1-800-292-5109 (commercial and Medicare Advantage) or 1-844-279-7140 (Medicaid Managed Care).
Important: If the initial PAP equipment authorization request was entered in Clear Coverage, enter the compliance recertification information in the Notes tab. Do NOT enter a new authorization request. For helpful information see our tip sheet, Clear Coverage CPaP/BiPap Extension of Initial Authorization Entry Tips, which will be available prior to November 5 at Provider.ExcellusBCBS.com. Go to: Resources > Staff Training > SearchTip Sheets.
CPT codes for in-laboratory sleep studies and PAP devices requiring preauthorization are:
E0470, E0471, E0601, E0561, E0562, 95782, 95783, 95803, 95805, 95807, 95808, 95810, 95811, 94660, E0561, E0562.
The preauthorization requirement for home sleep studies and supplies will be removed as of November 5; however, the Health Plan will continue to monitor utilization rates. CPT codes that will no longer require preauthorization are:
A4604, A7027-A7039, A7044-A7046, 95800, 95801, 95806, G0398-G0400
These sleep management updates apply to all lines of business that require preauthorization
If you have a question about this change, or are new to Clear Coverage, you can schedule training by contacting your Provider Relations representative. You may also find our Provider Resource Guide helpful. Find it at Provider.ExcellusBCBS.com. Click on the Authorizations tab and then on Preauthorization.