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BCBSMA New Utilization Management Program

Blue Cross Blue Shield of Massachusetts is initiating a new utilization management program for certain services for their Commercial EPO and PPO Members. These requirements have been in place for their HMO and POS membership and this change aligns their EPO and PPO products with them. Additionally, they are implementing these medical policies for their Medicare Advantage members. 

Authorization for these services will be required for dates of services on or after January 1, 2022. Please visit BCBSMA's UM program(s) for additional information regarding services. Please note that:

  • Providers can contact the authorization area by calling 1-800-676-BLUE or by calling the Pre-Authorization number on the back of the member's card
  • As always, they recommend checking benefits and eligibility to determine the member's benefits and any authorization requirements
  • All services must continue to meet medical necessity criteria. They will only provide reimbursement for services that meet these requirements and for which a prior authorization has been obtained
  • The Medical Policy Router and the General Pre-Requirements will be updated by January 1, 2022.

If you have additional questions regarding this latest news article, you can contact your BCBSKS provider consultant/representative.

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