Updating changes to your Provider Authorization form
Blue Cross Blue Shield of Michigan is dedicated to safeguarding the protected health information of our members. These safeguards include completion of a Trading Partner Agreement and Provider Authorization form as part of the electronic data interchange setup process. All EDI trading partners must complete a TPA and Provider Authorization form before they can exchange PHI with Blue Cross.
Terms of the TPA require you to notify Blue Cross of any changes in your trading partner information. If you switch service bureaus (clearinghouses), software vendors, billing services or the recipient for your 835 files, you must update your Provider Authorization form. Updating the form ensures information is routed to the appropriate destination. You don’t need to update the Provider Authorization form if your submitter and Trading Partner IDs don’t change.
You should review your provider authorization information if you’ve:
- Joined a new group practice
- Left a group practice and now bill using your own NPI
- Hired a new billing service
- Started submitting claims through a clearinghouse or you’ve changed clearinghouses
- Decided you no longer want to receive 835 remittance files
- Selected a new destination for your 835s
You must update your Provider Authorization form if you’ll be sending claims using a different submitter ID or routing your 835s to a different unique receiver or Trading Partner ID. To make changes to your EDI setup, visit bcbsm.com/providers and follow these steps:
- Click on Quick Links.
- Click on Electronic Connectivity (EDI).
- Click on How to use EDI to exchange information with us electronically.
- Click on Update your Provider Authorization Form under EDI Agreements.
If you have any questions about EDI enrollment, contact the EDI Help Desk at 1-800-542-0945. For assistance with the TPA and Provider Authorization form, select the TPA option.
The Physical Therapy Administrative Rules, which have the weight of law, have been revised and were officially adopted late December 2019. Click here for the new Rules. Administrative rules are an interpretation and implementation of statute, and are periodically reviewed and revised, even when there has not been a change in statute.
This most recent revision included a variety of clarifications . Click here for the summary provided by LARA. One clarification has important implications for supervision of and delegation to an athletic trainer by a physical therapist in a physical therapist practice. The MPTA and the Michigan Athletic Trainers’ Society (MATS) have jointly written an informational memorandum to inform our respective members about this important clarification.
We are very excited to announce the introduction of Senate Bill (SB) 612 which seeks to reform prior authorization practices in Michigan. This bill is the result of our collaboration with a large provider and consumer advocacy group coalition called Health Can’t Wait. The legislation is but 1 component of the this campaign that also includes consumer education and collection of patient stories.
The bill is sponsored by Senator Curt Vanderwall (Benzie, Crawford, Kalkaska, Lake, Leelanau, Manistee, Mason, Missaukee, Ogemaw, Osceola, Roscommon and Wexford). The most important parts of the bill that impact physical therapy include:
- Requiring payers to post prior authorization requirements on their public website and be readily available to providers at the point of care
Criteria that are based on peer-reviewed clinical review criteria which:
- Must be based on national association guidelines
- Account for atypical patient populations/diagnoses
- Ensure quality of care
- Be flexible for case-by-case deviation
- Evaluated and updated annually
- Be developed with input from health professionals licensed in the same profession
- Requiring payers to “conspicuously” post statistics about denials and appeals, including the top 10 reasons for denial, on their public website
Please contact your State Senator and State Representative NOW and tell them about the adverse impact that prior authorization is having on our ability to deliver medically, necessary care to our patients. For more information on the Health Can’t Wait coalition and to submit your patients’ stories, visit https://www.healthcantwait.org/
Meridian Medicaid now requires pre-treatment authorization, and has implemented eviCore’s Core-Path process similar to BCN and MPB.
Meridian states the authorization may take up to 14 days, but early indicators have shown a much shorter time frame. This was implemented November 1, 2019.
In recognition of the ongoing challenges faced by our members related to payment, the MPTA Board established a part-time Payment Specialist position. We are happy to announce that Barbara Herzog, PT will be working in this position. Her full bio is below. To contact Barb with your questions and concerns, email [email protected]. After verifying your membership status, Barbara will respond.
Barbara Herzog, PT - MPTA Payment Specialist
Barbara Herzog has been a physical therapist in Michigan for 38 years after graduating from the College of St. Scholastica, Duluth, MN. She spent the majority of her career in private practice owning a contract/personnel placement company, Private Practice/Rehab Agency, and medical wellness/fitness center and eventually selling those businesses in 2011. During that time, she was active in advancing private practice, fair reimbursement and the recognition of physical therapy services as a profession not only in private practice but in settings such as home care, worker’s comp and auto.
Barbara’s professional membership includes multiple years with PTPN as president, and she has been a member of APTA/MPTA since 1988. She has been continually active with APTA/MPTA serving as Vice President 2009-2010, federal affairs liaison, legislative committee member and payment and policy committee member. She has worked closely with multiple commercial insurance companies, self-insured employers, TPA’s, and other entities to facilitate and negotiate equitable payment and policies for the physical therapy profession in all settings. She attends payer meetings – Worker’s comp, HMO’s, commercial insurance PPO’s, and state funded plans.
Barbara remains a passionate practicing PT, currently working in several practice settings: hospital out-patient, private practice clinic and home health.