1. Web Authorization Submission BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. BlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association, An Association of Independent BlueCross and BlueShield Plans. CPT® is a registered trademark of the American Medical Association This document has been classified as public information.

2. 2 Authorization Submission Enter user ID and password to log in to the secure area of bcbst.com.

3. 3 Authorization Submission Select “Commercial/BlueAdvantage/BlueCare/TennCareSelect to begin the authorization submission process.

4. 4 Authorization Submission All Web functions can be accessed through the left-hand menu.

5. 5 Authorization Submission Select “Patient Inquiry” to view benefits, claims and other coverage.

6. 6 Authorization Submission All authorizations are initiated under “Authorization/Advance Determination Submission.”

7. 7 Authorization Submission Authorizations for inpatient confinement, 23-hour observation, outpatient procedures, specialty pharmacy, global obstetrics, and clinical updates can be submitted online.

8. 8 Authorization Submission Select the appropriate authorization to begin the authorization process.

9. 9 Authorization Submission Enter the requested admit date in MM/DD/YYYY format, then select a member by entering the appropriate member ID number without the three-letter prefix, then select “Search.” The yellow dot indicates the stage of the process.

10. 10 Authorization Submission Highlight correct member and click. Member information will auto-populate into the correct fields.

11. 11 Authorization Submission Enter Provider, Facility and Confinement Information. (Note: the yellow dot has progressed to the next stage)

12. 12 Authorization Submission Enter Provider and Facility ID numbers if known. “Search” for Provider and Facility ID numbers if not known.

13. 13 Authorization Submission Search for Providers by entering ID, name or location, then clicking “Search.” A list of possible matches will be created. Click the correct provider to auto-populate the authorization request.

14. 14 Authorization Submission Reminder: All fields with an asterisk must be completed. ICD-9 codes should omit decimals. Dates are in MM/DD/YYYY format. Emergency admits can be backdated four days.

15. 15 Authorization Submission Select the appropriate options from drop-down menus.

16. 16 Authorization Submission Procedure codes are only needed for elective surgery authorizations.

17. 17 Authorization Submission Milliman Care Guidelines criteria are selected by default and are necessary to obtain immediate online authorization.

18. 18 Authorization Submission Note any pertinent member co-morbidities/history in the text field. This note field can also be used to list secondary physicians, diagnosis or procedure codes. If Milliman Care criteria are not applied, supporting information is required here and the authorization request will be pended for review. When this screen is complete, choose “Continue.” This field is required when option was chosen to skip Milliman Criteria and pend to BCBST nurse for review.

19. 19 Authorization Submission When the screen is completed, a summary screen will be shown. Please review the information for accuracy and provider network status.

20. 20 Authorization Submission If changes are needed, click “Back” to go back and correct the information. When all information is correct, click “Continue.”

21. 21 Authorization Submission Apply Milliman Criteria The system will show the most appropriate guidelines, based on diagnosis or procedure codes entered. If one is appropriate, click the box next to it and select “Continue.”

22. 22 Authorization Submission Apply Milliman Criteria You may also find guidelines by selecting “Show All Guidelines” and “Search Guidelines.”

23. 23 Authorization Submission Click “Show All Guidelines” to bring up a drill-down menu. Click “+” to drill down to the appropriate condition, then select the guideline. Authorization Submission

24. 24 This example is being searched by description. Select “Search” after entering code or description. The “Search Guidelines” option will bring up a search screen and can be searched by ICD-9, CPT ® Code or guideline description. Authorization Submission

25. 25 Authorization Submission The Search screen will bring up the guidelines most closely associated with your search criteria. Select the appropriate guideline and click “Continue.”

26. 26 Authorization Submission Select all that apply, then click “Continue.”

27. 27 Authorization Submission A summary screen will show selected criteria.

28. 28 Authorization Submission If the clinical information submitted meets the criteria, an authorization number will be given. Print this page for your records.

29. 29 Authorization Submission If the guideline is determined to be more suited for 23-hour observation, the user can either accept the observation or request pending status for further medical review. If the physician is a Gold Card provider, the Gold Card option will be offered here.

30. 30 Authorization Submission If you choose to pend the authorization for further medical review, a screen will be generated to allow you to submit additional clinical information.

31. 31 Authorization Submission Notes are required when the authorization is pended for further medical review. When notes are complete, choose “Finish.”

32. 32 Authorization Submission Authorizations that pend will generate a confirmation number. The confirmation number may be used to check status of the request online. A nurse will call with the decision.

33. 33 Questions?

34. 34 Authorization Submission Clinical Update Submission Select “Clinical Update” to update initial authorizations submitted on the Web.

35. 35 Clinical Update Submission Use the Quick Locator to key in the confirmation or reference number and click “Go,” or double click the correct confirmation number.

36. 36 Clinical Update Submission You may choose to view Group- or Facility-submitted Web authorizations.

37. 37 Clinical Update Submission Provide contact information and phone number.

38. 38 Clinical Update Submission Click the “Note Type” drop-down box under “Service Information” to select the type of request being submitted. Note: For a DRG facility, choices for “Note Type” will be “DRG Conversion Request” or “DRG Threshold Update.”

39. 39 Clinical Update Submission Select number of days requested. * Required Field

40. 40 Clinical Update Submission Provide clinical information in the Clinical Notes box and “Submit.” It’s very important to date the clinical information.

41. 41 Clinical Update Submission Print the confirmation page for your records. Click “Return” to submit another clinical update submission.

42. 42 Questions?