CommercialPrior AuthHigh impact
Network News - 2nd Quarter 2018
Blue Cross and Blue Shield of Louisiana·LA · Orthopedics, General Surgery·Provider News
Effective date
Sep 1, 2018
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Louisiana is expanding their musculoskeletal (MSK) utilization management program to require prior authorization for joint surgery including large joint replacement and arthroscopy of hip, knee and shoulder, effective September 1, 2018. Claims without prior authorization will be denied for post-claim review.
Action Required
By August 27, 2018: Billing team must implement prior authorization requirement for all MSK joint surgery services including large joint replacement and arthroscopy of hip, knee, and shoulder through AIM ProviderPortal via iLinkBlue (www.BCBSLA.com/ilinkblue) or by calling 1-866-455-8416. Update scheduling workflows to obtain authorization before September 1, 2018 service dates. Note: Authorization requests will be approved even without medical necessity between August 27 - October 26, 2018, but starting October 27, 2018, services not meeting criteria will be denied as not medically necessary.