The following is a late breaking announcement from Bluechoice Healthplan of South Carolina:
Effective immediately, BlueChoice HealthPlan is implementing a Musculoskeletal Care Management (MSK) program. This program requires prior authorization for two components of non-emergent MSK:
Outpatient interventional spine pain management services
Inpatient and outpatient lumbar and cervical spine surgeries.
Why are we offering this service?
The estimated financial costs related to musculoskeletal pain is currently $874 billion, exceeding the cost of heart disease, cancer, or diabetes. BlueChoice® decided to implement this program to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.
What do members have to do?
Members who receive any of these services on or after May 1 will need to make sure their providers get prior authorization. BlueChoice has proactively reached out to our providers to educate them about the process. Please note that only outpatient procedures require prior authorization. All interventional pain management procedures performed in the emergency room or as part of inpatient care do not require prior authorization.
National Imaging Associates (NIA) Magellan Healthcare Inc. will manage the advanced imaging program. The interventional pain procedures are part of that program. NIA Magellan Healthcare Inc. is an independent company that provides utilization management services on behalf of BlueChoice. BlueChoice currently use NIA to manage pre-certifications for imaging services like positron emission tomography (PET) scans and magnetic resonance imaging (MRI). This program will be an extension of those services.