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New Electronic Preauthorization Tool Update

You were notified in September of our intention to provide you with a new electronic preauthorization system – CareAdvance Provider®, which will replace our current tool, Clear CoverageTM. We would now like to provide an update regarding the implementation time frame and an additional line of business involved in the initial phase.

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Hospice Benefit Clarification

Once a member begins receiving hospice services, all care for their terminal illness will be coordinated by the hospice organization.  A review of our records indicates that hospice services for our members who have commercial or Medicaid Managed Care coverage may have been reimbursed improperly by the Health Plan. The hospice organization that provided the services should have been the responsible payer.

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Update to Prepayment Review of Institutional Inpatient BlueCard® Claims

Excellus BlueCross BlueShield would like to make you aware that the threshold for institutional inpatient BlueCard claims requiring prepayment review is being reduced from $250,000 to $200,000. Effective January 1, 2020, these claims received from participating acute-care providers with a total allowed amount over $200,000 must include an itemized bill.

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