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Changes to prior approval and inpatient admission certification requirements

Prior approval and inpatient admission certification for mental health and substance abuse services will no longer be required for Blue Advantage® members (using the Blue OptionsSM network) with an enrollment date on or after July 1, 2004. Prior approval and inpatient admission certification for mental health and substance abuse services will also not be required for AccessSM1, Blue AssuranceSM or Comprehensive Major Medical Conversion plans using the Classic Blue® network on or after January 1, 2005.

Prior approval and inpatient admissions certification for mental health and substance abuse through Magellan Behavioral Health is still required for all other Blue Options plans.

To determine if a Blue Advantage member is assigned to the Blue Options network, look for the alpha prefix "YPP" preceding the ID number on the member’s BCBSNC ID card. Likewise, to determine if a member is assigned to Access, Comprehensive Major Medical Conversion or Blue Assurance under Classic Blue, look for the alpha prefix "YPM" preceding the member’s ID number.

If you have additional questions, please call your local Network Management field representative.