November 16, 2017
Beginning January 1, 2018, Microsoft is making several changes related to benefits for employees and dependents. Prior authorization will be required for outpatient rehabilitation and imaging services. Progyny Patient Care Advocates, a leading fertility benefits company, will administer infertility services.
All the changes below are effective as of January 1.
Outpatient rehabilitation services
Outpatient rehabilitation services for Microsoft patients will require prior authorization through eviCore. We partner with eviCore for medical necessity review and authorization for outpatient rehabilitation services. This includes services for physical and occupational therapy. Prior authorization won't be required for massage therapy.
If eviCore determines that the services provided weren't medically necessary, or you didn't submit a request for review, the claim will deny as provider liability. To learn more about eviCore or how to submit a treatment request, visit evicore.com/Healthplan/Premera.
Advanced imaging services
Premera Blue Cross partners with AIM Specialty Health® (AIM) to review advanced imaging requests for medical necessity and appropriateness. Advanced imaging services for Microsoft patients will require prior authorization through AIM. If AIM determines that the services provided weren't medically necessary or you didn't submit a request through the AIM Provider website, the claim will deny as provider liability and we won't reimburse you for the service. To review AIM's criteria, visit their website at aimspecialtyhealth.com.
Infertility benefit change
Premera Blue Cross won't administer infertility treatment services for Microsoft patients. Progyny Patient Care Advocates will administer these services. You can reach Progyny Patient Care Advocates at 888-203-5066 for any questions regarding care with dates of service on or after January 1, 2018. Premera will continue to cover services to evaluate potential infertility under the standard Microsoft medical benefit.