​​Upcoming PEAR PM self-service requirements

November 18, 2021

PEAR Practice Management (PM) offers online transactions that allow your practice to perform self-service functions at your own pace to provide efficient patient care.

As of January 1, 2022, all participating providers, facilities, Magellan-contracted providers, and third-party organizations that support our provider organizations will be required to complete these self-service functions using PEAR PM:

  • Verify member eligibility. Use the Eligibility & Benefits transaction to view detailed information relating to our members' eligibility.
  • Check claim status. Use the Claim Search transaction to view the progress of your accepted claim submission. You can view claims with service dates up to 18 months in the past.
  • Submit claim adjustments and inquiries.* Request a claim review or adjustment through the Claim Search transaction. Use the Create New Investigation button to start a new investigation on a finalized claim. Claim investigation submissions are permitted within 18 months of the date of the finalized claim.
  • Submit authorizations. Use the Authorization Submission transaction to initiate requests for these service types:​​
    • ​ambulance​​
    • amb​ulatory infusion chemotherapy
    • ambulatory infusion suite therapy
    • chemotherapy
    • 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

Over the next few weeks, we will share tips to help you get acclimated to using these self-service functions and prepare you for the upcoming requirements. 

Need help?

Review the transaction-specific user guides, videos, and eLearning courses available 24/7 on the PEAR Help Center.

If your organization has not yet registered for PEAR, learn more here. To confirm or update provisioning for PEAR PM, contact your organization's designated Organization or Location Administrator.

 

*Not available for Independence Administrators.

Some authorizations must be submitted via AIM or eviCore, independent companies. Use the AIM and eviCore transactions in PEAR PM to initiate the process. For other service types not listed, please contact 1-800-ASK-BLUE and follow the prompts for authorizations.

For Independence Administrators, use the iEXCHANGE® transaction in PEAR PM to request authorizations.

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.​