NY Empire Blue Cross Blue Shield Precertification Request 2019-2025 free printable template

Recertification Request To prevent delays in processing your prior authorization request, fill out this form in its entirety with all applicable information and fax to Empire Blue Cross Bluesier Healthful

How to fill out empire bcbs prior authorization

How to fill out NY Empire Blue Cross Blue Shield Precertification

1. Obtain the precertification form from the Empire Blue Cross Blue Shield website or your healthcare provider.
2. Fill in the patient's personal information, including their name, date of birth, and member ID.
3. Specify the procedure or service for which precertification is being requested.
4. Provide relevant medical information, including diagnosis codes and any supporting documentation from the healthcare provider.
5. Include the name and contact information of the healthcare provider requesting the precertification.
6. Review the form for accuracy and completeness before submission.
7. Submit the completed form via the preferred method (online, fax, or mail) as indicated by Empire Blue Cross Blue Shield.
8. Follow up with Empire Blue Cross Blue Shield to confirm that the precertification has been received and is being processed.

Who needs NY Empire Blue Cross Blue Shield Precertification?

1. Patients seeking specific medical procedures or services that require approval from Empire Blue Cross Blue Shield.
2. Healthcare providers who are submitting requests for services on behalf of their patients that require precertification.
3. Individuals with insurance plans that mandate precertification for certain medical services to ensure coverage.

People Also Ask about

Which plan does not require authorization?

No pre-authorization is required for outpatient emergency services as well as Post-stabilization Care Services (services that the treating physician views as medically necessary after the emergency medical condition has been stabilized to maintain the patient's stabilized condition) provided in any Emergency Department

Does Empire Plan require prior authorization?

If the prior authorization review results in authorization for payment, you will receive Empire Plan Prescription Drug Program benefits for the drug. If the payment is not authorized, no Empire Plan Prescription Drug Program benefits will be paid for the drug.

What is the provider line for Empire BCBS?

Provider Services: Call the number on the back of the member's ID card or call 800-676-BLUE (2583) to speak to a Provider Service representative.

Does Nyship Empire plan require a referral?

Your Empire Plan participating provider The Empire Plan does not require that a participating provider refer you to a participating specialist, laboratory, urgent care center or outpatient surgical locations.

What is the payer ID for Empire BCBS claims?

Your Payer ID is 27514. Note: If you use a billing company or clearinghouse for your EDI transmissions, please work with them on which payer ID they want you to use.

Can you skip prior authorization?

Under medical and prescription drug plans, some treatments and medications may need approval from your health insurance carrier before you receive care. Prior authorization is usually required if you need a complex treatment or prescription. Coverage will not happen without it.

Which procedure requires prior authorization?

Do all medical services performed require prior authorization? No. Prior authorizations are usually only required for more costly, involved treatments where an alternative is available. For instance, if a physician prescribes an invasive procedure such as orthopedic surgery, it will likely require preauthorization.

How do I submit a claim to Empire BlueCross BlueShield?

How To Submit An Empire Claim Yourself. Typically, your doctor or provider, especially if they're in your plan, will submit the claim for you. In some cases when you visit a doctor outside your plan, you may have to do this yourself. You can access claim forms in our Forms Library.

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What is NY Empire Blue Cross Blue Shield Precertification?

NY Empire Blue Cross Blue Shield Precertification is a process that requires healthcare providers to obtain approval from the insurance company before certain services or procedures are performed to ensure they are medically necessary.

Who is required to file NY Empire Blue Cross Blue Shield Precertification?

Healthcare providers, including physicians and facilities, are required to file NY Empire Blue Cross Blue Shield Precertification requests for specific services or procedures that may require prior approval.

How to fill out NY Empire Blue Cross Blue Shield Precertification?

To fill out the NY Empire Blue Cross Blue Shield Precertification, providers should complete the precertification form with relevant patient and service details, including the patient's information, the procedure code, and medical necessity justification.

What is the purpose of NY Empire Blue Cross Blue Shield Precertification?

The purpose of NY Empire Blue Cross Blue Shield Precertification is to assess the medical necessity of certain procedures and services, ensuring that they meet the criteria for coverage under the insurance policy.

What information must be reported on NY Empire Blue Cross Blue Shield Precertification?

The information that must be reported includes the patient's demographic details, the provider's information, the specific procedure or service requested, supporting clinical documentation, and the rationale for requesting the service.