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Prior Authorization Services (FAQ)

Effective April 26, BJC HealthCare will expand prior authorization services for selected specialties. Below are Frequently Asked Questions regarding Phase I of the rollout.

1. What specialties are included in Phase I?

Family Medicine
Internal Medicine
Neurology
Neurosurgery
Orthopedics
Orthopedic Surgery
Otolaryngology (ENT)
Physical Medicine and Rehabilitation
Pulmonology
Radiation Oncology

2. How do I participate in prior authorization services?

All Washington University, BJC Medical Group, and private practice providers whose primary specialty falls within Phase I are automatically included in the rollout.

3. What is the authorization process?

Submit order as you normally do. The BJC Pre-Arrival Team will complete the authorization process and contact your office if other information is required.

4. Which tests will be authorized by the BJC Pre-Arrival Team?

MRI
CT*
PET
Nuclear Medicine
Interventional Radiology (IR)
CV Cardiac
CV Echo
CV Stress
Sleep
Neurology (EEG only)

*Excludes CT lung cancer screening

5. Are there any exceptions to prior authorization services?

CT lung cancer screening program
United HealthCare and Gateway to Better Health encounters
Anything scheduled within two (2) business days of the visit is considered urgent and the referring provider is responsible for obtaining the authorization.*

*Hospitals currently offering same day/2 day prior authorization services will continue to do so after April 26.

6. What happens to referrals before April 26?

Any referrals with a April 26 and April 27 scheduled date of service will remain the responsibility of the referring provider. New referrals with appointment dates of April 28 and forward will route to the BJC Pre-Arrival Team.

7. Will this change workflows for my practice?

Epic providers: There will be some changes related to Epic referral flags which are used for notification of peer-to-peer, denial or the need for additional clinical information. HIP Tips and the Epic Training Team will be available to assist as needed.


Non-Epic providers: Workflows will not change.

8. Can the ordering provider see what has been documented in Epic or EpicCare Link?

Yes. Providers on Epic and EpicCare Link may view the BJC Pre-Arrival Team’s documentation in the “Notes” section of the referral.

9. If my specialty is not on the list, when will I be able to participate?

Specialties scheduled in the next phases are below. Rollout dates are TBD:

Phase 2: Gastroenterology, Pain Management, Surgery, OB/GYN, Ophthalmology and Pediatrics

Phase 3: Cardiology, Radiology

Phase 4: Transplant, Oncology and Pediatric Oncology

Prior authorization services for Parkland Health Center will include all specialties listed in phases 1, 2 and 3 on April 26.

Prior authorization services for Belleville/Shiloh Memorial will roll out in Phase 3 and include all specialties listed in Phase 1, 2 and 3.

If you have any questions, please email the BJC Pre-Arrival Team at BJCPreArrivalAuth@bjc.org or call 314-747-5050.