Blue Cross Blue Shield of North Dakota (BCBSND) wants to give more information to providers regarding the upcoming change to the new precertification tool, Predictal.
As described in our previous Preparation for the Rollout of the New Predictal Precertification Tool article and the Quarterly Provider Insights, this tool is integrated with the Availity Essentials provider portal and designed to provide you with a faster pathway to submitting and viewing precertification request(s). The implementation of this tool will go live on Saturday, Nov. 11, 2023.
BCBSND has created a new online step-by-step resource guide to help you navigate this change, which can be found under the Policies and Precertification section of www.bcbsnd.com. For your convenience here is the direct link.
Key notes about this transition:
- The browser utilized should be Google Chrome.
- With this change, BCBSND will no longer provide detailed rationale for denied determinations on the fax returned to the provider. A letter containing rationale details will continue to be mailed to providers after the determination is made.
- In addition, a faxed precertification request, will not display on the Availity Essentials dashboard. While it can be searched for manually, the timeliest option would be to enter all authorization requests directly in the Availity Essentials portal.
- To get the rationale earlier a provider can use Availity Essentials to enter the authorization. Entering an authorization request directly within Availity Essentials provides a real time response to the review and will offer full rationale details when the review is complete.
- Any precertification requests submitted prior to the Predictal go-live, will be reviewed according to the current process. New requests submitted after go-live will be reviewed according to the new Predictal process.
- With this transition, providers will be able to utilize their dashboard for precertification request status updates. However, concurrent review requests that come in for a previously submitted precertification, will not show on the Availity dashboard during the go-live transition. The reason for this is the request in Predictal will be cancelled and our UM team will complete it in the prior system, where the original precertification request is. Providers will still receive a letter and a fax with the determination. As of Saturday, Nov. 11, 2023, providers will enter precertification’s in Predictal, they will not need to do anything different than instructed in the Predictal resource guide for concurrent reviews.
- In the event a provider submitted precertification request is not entered into Predictal correctly, our Utilization Management (UM) team may need to fix the request and re-enter the information. If this occurs, the response will be treated like a fax request.
- If you chose to not use Availity Essentials for electronic authorization submission, and decide to do fax instead, you can reference the letter in the mail for the information necessary to support the fax.
- If you do not receive the letter, you can contact the Provider Service Contact Center phone number on the back of the members ID card.
- Ensure all documentation to support the medical necessity of the service you are requesting is included before submitting your request. Providers will not be able to attach documentation after a case is submitted to BCBSND for review unless a request for more information is requested from the UM team.
As a reminder, you still have time to verify your Availity Essentials access with your administrator if you will be submitting precertification requests for your office. If you have access to the Patient Registration, Authorization & Referrals tab within Availity Essentials today, you should not need to do anything further.
If you have any questions regarding this change, contact firstname.lastname@example.org.
For questions related to Availity Essentials registration or administrator functions, contact Availity Essentials Client Services at 1-800-282-4548.