Regence BCBS to require Prior Authorization for Acupuncture

10/6/2013

In case you hadn't heard the news, Regence Blue Cross Blue Shield is recommending pre-authorization for Acupuncture services for all members starting November 1, 2013 in Oregon, Washington, Idaho and Utah. Starting February 1st, 2014 this will be a requirement, not just a recommendation.

The full details of this change can be found HERE on the Regence Oregon website.

It looks like the process will be pretty easy and handled by an organization called CoreCare National, LLC. You will have to register your credentials with them and can either call or go online to obtain a pre-authorization for the specific diagnosis code and CPT codes you want to bill for.

A complete list of all the CPT codes required to get pre-authorization for is on the Regence site linked above, or HERE if you want to go direct.

Its been clear for the past year that Regecen has really been buttoning down on Acupuncture. Regence used to have some of the best reimbursement rates in my practice and now it is one of the lower eschelon to be sure. This move does not have me hopeful of a strong reimbursement rate in the future as the Affordable Care Act gets into full swing, but we'll just have to take it step by step and see what happens in the coming years.

For now, if you are a preferred provider with Regence in Oregon, Washington, Idaho or Utah its time to get signed up with CCN and start familiarizing yourself with the pre-authorization process. Regence is offering several webinars about it this month. They are free and you can sign up through the Regence page linked above.

Good luck all you Acu-Stars out there, lets keep fighting the good fight!
~Rebecca Hurwood, LAc

3 Comments

Michelle Thelen link

10/12/2014 04:28:11 am

I'm considering a move to Washington State, and have talked to a provider there (acupuncture) and she told me that the biggest insurers are not accepting new applications at all. I'm just wondering if you know what to expect as a new provider. Will I only be able to sign up with a couple of insurance companies, or will the larger ones open up their gates someday? I appreciate any help you can give. Thanks

Rebecca Hurwood link

10/13/2014 09:46:04 am

Hi Michelle,

That's a tough question because there's no magical list that tells you what insurers are currently accepting new providers and what insurers are not. I've been in practice almost 9 years now and I can definitely tell you that the landscape has changed quite a bit with what you would expect - more competition in the larger urban areas, lower reimbursement rates - but not so bad that I wouldn't recommend the Pacific NW (It's just so dang cool here!!). That said, I think as new provider in the area you can expect that having a strong niche market and being focused on marketing as a regular part of your practice will be important for success. If you want to know more about the major insurers, you'll have to call them about if their panels are opened or closed. Registering with CAQH, if you aren't already, and making sure your credentials are up to date there will help - many insurers will just pick you up off of their without having to do anything. And the sooner you start submitting information about your new practice to the insurers the better - it can often take 30 to 60 days for them just to update your records, let alone process a new application - so if you want to bill smoothly, the early bird definitely gets the work. It is always worth it to call (with annoying frequency) if you really want to get on a closed panel. Spots do open up and it is usually the most persistent practitioners that make the list. It took me two years of badgering Kaiser to get on their panel, but I did it and got on relatively early compared to many of my colleagues and it was definitely worth the work. I hope that helps, Michelle, good luck! - Rebecca

Rebecca Hurwood

10/13/2014 09:47:12 am

I meant "worm" not work... typing to fast!!

Author

Rebecca MH Kitzerow is a Licensed Acupuncturist working in Portland, Oregon and La Center, WA. Dedicated to her practice, her family and the entrepreneurial small business spirit, Rebecca wrote Insurance Billing Made Easy in 2010 as an attempt to help other practitioners learn concisely what she had to figure out by trial and error - that a little know how + a willingness to jump in and try go a long way to making billing insurance a breeze. Rebecca currently runs a solopreneur practice and completes her insurance billing in 20 minutes a week. She's here to show YOU how to do it too!

Regence BCBS to require Prior Authorization for Acupuncture

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