CommercialPrior AuthHigh impact
Network News - 1st Quarter 2019
Blue Cross and Blue Shield of Louisiana·LA · Cardiology, Family Medicine, Internal Medicine·Provider News
Effective date
Jun 1, 2019
We identified it
Jun 20, 2026
Summary
Blue Cross and Blue Shield of Louisiana will require prior authorization for fractional flow reserve using CT (FFR-CT) procedures effective June 15, 2019. Additionally, incident-to billing rules are changing June 1, 2019 - providers eligible for network participation (NPs, PAs, etc.) must bill under their own provider numbers instead of supervising physicians.
Action Required
By June 1, 2019: Update billing system so nurse practitioners, physician assistants, dietitians, audiologists, certified nurse anesthetists, and applied behavior analysts bill under their own provider numbers instead of supervising physicians. By June 15, 2019: Implement prior authorization requirement for FFR-CT procedures (CPT codes 0501T-0504T) in billing system. Contact AIM Specialty Health for authorizations. Claims without prior auth will be denied or penalized.