Background: The Blue Cross and Blue Shield Plans launched a tool on January 1, 2014, that gives providers the ability to access out-of-area member’s Blue Plan (Home Plan) provider portals to conduct electronic pre-service review. Electronic Provider Access (EPA) enables providers to use their local Blue Plan provider portal to gain access to an out-of-area member’s Home Plan provider portal, through a secure routing mechanism. Once in the Home Plan provider portal, the out-of-area provider will have the same access to electronic pre-service review capabilities as the Home Plan’s local providers.
Definition: Pre-Service Review: The term pre-service review is used to refer to pre-notification, pre-certification, pre-authorization and prior approval, amongst other pre-claim processes.
EPA gives out-of-area providers access to the member’s Home Plan portal, through local Blue Plan portals, to conduct pre-service review. The provider will continue to use the local Blue Plan portal, following the local plan's authentication process. As a Highmark Blue Shield of Northeastern New York provider, you will initiate this process via NaviNet's Authorization Submission transaction by selecting the option Pre Service Review for Out of Area Members.
Last updated on 10/28/2021 2:42:24 PM