Differences Among Payers

We know that for providers who may be contracted with more than one insurance payer, remembering the differences among payer requirements and guidelines can be complicated. See below for a quick overview of the differences in review criteria among the payers you are submitting authorizations for.

Payer	Edits	Continuations	Duplications	Voids
Avera	You are able to make certain edits to authorizations that are pended or still a draft (e.g., date). Please visit this page for more information.	A new authorization request will need to be submitted. No continuations are allowed.	If the portal detects a duplicate request, the portal will notify you of the potential duplicate.	You can withdraw a request that is pending. You can void a case at any point in the decisioning process.
BlueCross BlueShield of South Carolina	Edits to prior authorizations are not permitted.	For approved or partially approved authorization requests, you can use this feature to add units or procedure codes to a request. Continuations will go through a separate review and will have the same authorization number as the initial request.	If certain fields in a new authorization are identical to those in another request, you will be informed that it is a duplicate and will be unable to submit it until changes are made. These fields include: performing provider, facility, overlap of procedure codes, overlap of dates, and same encounter type (inpatient/ outpatient)	You can withdraw a request that is pending. You can void a case at any point in the decisioning process.
BlueCross BlueShield of Tennessee	You are able to make certain edits to authorizations that are approved, partially approved (N/A for Medicaid), pended, or still a draft (e.g., date). Please visit this page for more info.	A new authorization request will need to be submitted. No continuations are allowed.	If the portal detects a duplicate request, the portal will notify you of the potential duplicate.	You can withdraw a request that is pending. You can void a case at any point in the decisioning process.
Geisinger Health Plan	You are able to make certain edits to authorizations that are approved, pended, or still a draft (e.g., dates).  Please visit this page for more information.	For some approved or partially approved authorization requests, you can use this feature to add units or procedure codes to a request. Continuations will go through a separate review and will have the same authorization number as the initial request.  Please visit this page for more information.	If the portal detects a duplicate request, the portal will notify you of the potential duplicate.	You can withdraw a request that is pending. You can void a case at any point in the decisioning process.
Health Partners	You are able to make certain edits to approved or partially approved authorizations. Please visit this page for more information.	A new authorization request will need to be submitted. No continuations are allowed.	If the portal detects a duplicate request, the portal will notify you of the potential duplicate.	You can withdraw a request that is pending. You can void a case at any point in the decisioning process.
Humana	You are able to make certain edits to authorizations that are approved, pended, or still a draft (e.g., dates).  Please visit this page for more information.	For approved or partially approved authorization requests, you can use this feature to add units or procedure codes to a request. Continuations will go through a separate review and will have the same authorization number as the initial request.  Please visit this page for more information.	If the portal detects a duplicate request, the portal will notify you of the potential duplicate.	You can withdraw requests when they are pending. You can void cases while they are pending by calling Cohere at [phone]. You can mark a request as no longer needed after it has been approved.
Medical Mutual (MMO)	After the request is submitted and decisioned, edits cannot be made without calling Medical Mutual. However, as long as the status is still pending or open, additional information can be appended to authorizations, or they can be voided entirely.	Continuations for any requests are not accepted.	If certain fields in a new authorization are identical to those in another request, you will be informed that it is a duplicate and will be unable to submit it until changes are made. These fields include: performing provider, facility, overlap of procedure codes, overlap of dates, and same encounter type (inpatient/ outpatient)	You can withdraw a request that is pending.  If the status is still pending or open, additional information can be appended to authorizations, or they can be voided entirely.
	For Therapy, Chiropractic, Radiology, Cardiology, Sleep, and Gastrointestinal requests: Edits to prior authorizations are not permitted after an auth has been submitted.	For Therapy, Chiropractic, Radiology, Cardiology, Sleep, and Gastrointestinal requests: For some services, the continuations feature (revisions) can be used to add additional visits to approved requests.	For Therapy, Chiropractic, Radiology, Cardiology, Sleep, and Gastrointestinal requests: If certain fields in a new authorization are identical to those in another request, you will be informed that it is a duplicate and will be unable to submit it until changes are made. These fields include: performing provider, facility, overlap of procedure codes, overlap of dates, and same encounter type (inpatient/ outpatient)	For Therapy, Chiropractic, Radiology, Cardiology, Sleep, and Gastrointestinal requests: Cohere will not allow any users to Void an authorization that has been previously approved or denied.