New PA Checkpoint Tool to Go Live Jan. 16, 2024

An enhancement to our precertification search webpage called PA Checkpoint goes live Jan. 16, 2024.

Precertification, prior approval and prior authorization may be used interchangeably, but will refer to the same process. 

The launch of the PA Checkpoint tool will: 

• Help providers easily look up procedures before scheduling next appointment to determine if prior authorization is required.
• Help providers notify patients of any precertification requirements connected to their plan of care.
• Provide access to all policies a code may be addressed in.
• Allow providers to spend less time on the phone and more time helping patient.
• Provide a transaction ID reference number.

There are two main differences: 
1.    The same search tool will be used for Medicaid Expansion and the Commercial line of business. 
2.    After clicking on the search for prior authorization button, whether in or out of area, providers will be prompted to add additional information such as National Provider Identifier (NPI), Member ID (with the alpha prefix), date of service, and the procedure code.  

• A service description can also be used, however, due to set up of a code, results may not populate. Using a procedure code will yield the best results

Whether entering a procedure code or description, the generated information much be selected from the populated drop-down list, or an error message will display.

After the above information is completed and submitted, the prior authorization results will display. Two color categories may be displayed when applicable.

• Red  requires prior authorization or needs additional review before the service is rendered
  • Please look at the additional information section as well. This will provide any additional steps needed to determine if an authorization is required.
• Gray service does not require prior authorization.

Next steps may display. Read this information to determine if additional action is required. 

The results provided in the search will be based on the information at the time of the search. It is best practice to enter the expected date of service when possible.  

Please note, this tool does not constitute benefit verification. Providers still need to follow the standard process of checking eligibility and benefits status and network or referral information. It is also important to consider a member's coordination of benefits. Authorization requests do not need to be submitted on BCBSND secondary plans. 

If a length of time has passed since the initial verification and the service date is in the distant future or has changed, it is best practice to re-verify if prior authorization is required. Policies and criteria may change at any time. Claims received will process against applicable policies per the date the claim comes through the system, not based on date of service.  

This new tool will also be available for members to use on the website's member portion. Federal Employee Program (FEP), Medicare Supplements and NextBlue of North Dakota Medicare Advantage plans are excluded from this tool. 

Questions? 
If you have any questions regarding this change, contact prov.partners@bcbsnd.com or contact the Provider Service phone number on the back of the member ID card.