Electronic Provider Access (EPA) for Pre-Service Review

Background: The Blue Cross and Blue Shield Plans launched a new tool on January 1, 2014, that gives providers the ability to access out-of-area member’s Blue Plan (Home Plan) provider portals to conduct electronic pre-service review. Electronic Provider Access (EPA) will enable providers to use their local Blue Plan provider portal to gain access to an out-of-area member’s Home Plan provider portal, through a secure routing mechanism. Once in the Home Plan provider portal, the out-of-area provider will have the same access to electronic pre-service review capabilities as the Home Plan’s local providers.

Definition: Pre-Service Review: The term pre-service review is used to refer to pre-notification, pre-certification, pre-authorization and prior approval, amongst other pre-claim processes.

EPA will give out-of-area providers access to the member’s Home Plan portal, through local Blue Plan portals, to conduct pre-service review. The provider will continue to use the local Blue Plan portal, following the local plan's authentication process. As a Highmark Blue Shield provider, you will initiate this process via NaviNet's Authorization Submission transaction by selecting the option Pre Service Review for Out of Area Members.

Resources:

• EPA Tip Sheet
• Plan Implementation Schedule