June 16, 2014

HHA-14-3
DC-14-3
ASC-14-3
MS-14-4

BC-14-4
SA-14-3
HP-14-3
 

To:

All Blue Cross Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Blue Cross and Blue Shield of Kansas City Prior Authorization program

Blue Cross and Blue Shield of Kansas (BCBSKS) is providing this information regarding Blue Cross and Blue Shield of Kansas City (Blue KC) and their use of MedSolutions to provide authorization services in the event that BCBSKS contracting providers service a Blue KC member.

In an effort to improve the quality of care for their members, both in their service area and across the country, Blue Cross and Blue Shield of Kansas City (Blue KC) began using MedSolutions to provide authorization services for all of their members receiving outpatient high tech radiology and lumbar spinal fusions.  MedSolutions is a utilization management services organization specializing in the management of quality, cost-effective diagnostic services.

Effective for dates of service beginning October 1, 2013, outpatient and elective MRI, MRA, CT, CTA, PET, echocardiogram, nuclear cardiology studies and lumbar spinal fusions require prior authorization from MedSolutions for Blue KC members. Imaging performed in conjunction with an inpatient stay, 23 hour observation, or testing done in the emergency room is not subject to authorization requirements.

When imaging is required in less than 48 hours due to an urgent condition, providers should call for authorization and inform MedSolutions that the imaging is urgent and ask for an expedited review.

MedSolutions is ready to offer any implementation support to providers if necessary.  Please contact MedSolutions at 888-693-3211 with any additional questions about the program. In addition to calling to request an authorization, providers may access MedSolutions 24/7 web portal at www.medsolutionsonline.com or fax a MedSolutions request form (download form at www.medsolutionsonline.com) to 888-693-3210.

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