We continue to share tips to help providers and their administrative staff prepare for the upcoming
self-service requirements that begin
January 1, 2022. PEAR Practice Management (PM) offers transactions that can be used daily by your practice to provide efficient patient care.
TIP #8: Determining which transaction to use
Authorizations Submission transaction to submit requests for these service types:
- ambulance (land)
- ambulatory infusion chemotherapy
- ambulatory infusion suite therapy
- durable medical equipment – purchase and rental
- emergency hospital admission
- home health
- home infusion
- infusion therapy
- medical surgical procedures
- skilled nursing facility
- outpatient physical therapy and occupational therapy services specifically for Medicare Advantage members
Use the AIM transaction to connect to AIM’s ProviderPortal℠ to submit requests for:
- Cardiology Utilization Management Program
- Musculoskeletal Utilization Management Program
- Certain outpatient nonemergent diagnostic imaging services
- Sleep studies
eviCore transaction to connect to eviCore's portal to submit requests for:
- certain genetic/genomic tests for all commercial and Medicare Advantage members
- nonemergent outpatient radiation therapy services for all commercial and Medicare Advantage members
Use the iEXCHANGE® transaction to submit requests for Independence Administrators.
For other service types not listed, please contact 1-800-ASK-BLUE (1-800-275-2583) and follow the prompts for authorizations.
Review the Authorizations 101 or PEAR PM for AHA and IA user guide and eLearning course on the
PEAR Help Center.
This information does not apply to providers contracted with Magellan Healthcare, Inc. (Magellan). Magellan-contracted providers should contact their Magellan Network Coordinator at 1-800-866-4108 for authorizations.
Magellan Healthcare, Inc., an independent company, manages mental health and substance abuse benefits for most Independence members.