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News Archive

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Showing 1– 15 of 160 Results

Latest News

Medical Utilization Management Updates

Audience: All Providers, Facilities, Hospitals

We would like to share an overview with you regarding our standard medical Utilization Management (UM) Program updates coming soon.  Breast reconstruction, including implant insertion, removal or reinsertion continues to require pre-authorization unless the...

Reminder: Refund Request Notification Process

Audience: All providers

We are writing to remind you of our automated notification process for requesting a refund on any claim we paid or overpaid in error. When we process a retraction for claims we paid or overpaid in error, a refund request is immediately generated if we are unable to...

De-Implementing Temporary COVID-19 Hospital Contingencies

Audience: Participating Hospitals

On June 26, 2020, the New York State Department of Financial Services (NYS DFS) issued Supplement No. 2 to its Insurance Circular Letter No. 8. The supplement provides guidance that permits health insurers, including Excellus BlueCross BlueShield, to resume...

Medicare MS-DRG Payment Add-On for COVID-19 Hospitalizations

Audience: Participating Hospitals

Excellus BlueCross BlueShield has updated the weighting factor of the assigned Medicare severity  diagnosis-related group (MS-DRG) by 20 percent for COVID-19-related hospitalization claims processed  on or after June 12, 2020, for our Medicare Advantage...

Hyaluronic Acid Preferred Therapy Update

Audience: Specialty Providers

We want to make you aware of an upcoming change regarding treatment with hyaluronic acid therapy. Effective October 1, 2020, Euflexxa, Synvisc, and Synvisc-One will be our preferred hyaluronic acid therapy products for the treatment of pain in osteoarthritis (OA)...

Eyewear Benefit Clarification for MMC and HARP Members

Audience: Participating Vision Care Providers

We would like to provide clarification of the eyewear benefit for Medicaid Managed Care (MMC) and Health and Recovery Plan (HARP) members related to standard vs. non-standard/deluxe frames and lenses. This applies to our members with HMOBlue Option, Blue Choice Option,...

Hemlibra Requires Prior Authorization Effective October 1

Audience: Providers of Impacted Members

We would like you to be aware of an upcoming change related to the management of Hemlibra®. Starting October 1, 2020 , Hemlibra will be covered under the medical benefit and will require prior authorization for all Commercial, Medicare and Safety Net (Medicaid, HARP,...

Metformin ER Recall

Audience: Providers of impacted members

Amneal Pharmaceuticals LLC and Apotex Corp. are voluntarily recalling all lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 750 mg, within expiry to the Consumer Level. The recall is due to the potential N-Nitrosodimethylamine (NDMA) levels...

AP-34 Optometry Scope of Practice Administrative Policy Effective October 1, 2020

Audience: Optometrists

Excellus BlueCross BlueShield is implementing the following administrative policy October 1, 2020 , to define the coverage and billing guidelines for Optometry Scope of Practice. This policy is in line with Current Procedural Terminology (CPT), and Healthcare Common...

COVID-19 Reimbursement of Preventive Health Visits via Telehealth Extended to September 7

Audience: Participating Physicians

In our communication dated May 13, 2020, we shared the Health Plan’s commitment to ensure continuity of care for our members during the COVID-19 state of emergency, and our efforts to eliminate barriers to providing care during this unprecedented time.  We...

Musculoskeletal Preauthorization Procedure for Essential Plan Members Effective August 1

Audience: Physicians, Hospitals

We advise you that effective August 1, 2020, preauthorization requests for musculoskeletal procedures pertaining to Essential Plan members must be submitted directly to the Health Plan. Musculoskeletal-related requests for Commercial and Medicare Advantage business...

Requesting Additional Visits in CareAdvance Provider® Tool

Audience: Physical, Occupational and Speech Therapists

Please remember when requesting additional visits for an existing authorization in CareAdvance Provider, you must complete the following steps: Locate and open the authorization entry. Be sure you have the correct provider in focus in the top right corner using...

COVID-19 Diagnostic & Antibody Testing Administrative Policy & Information for all Lines of Business

Audience: Physicians, Hospitals, Facilities and Laboratories

In our communication to you dated May 21, 2020, we shared Health Plan coverage guidelines and member cost-share information related to COVID-19 diagnostic/viral and antibody testing for our commercial members. The information and guidance we shared in our May 21, 2020...

Electronic Submission Tools

Audience: All providers

To make it easier and more efficient to conduct business with our Health Plan, we are enabling more real-time automation to reduce your administrative burden. As part of our continuing effort to improve our service, we are offering the following electronic submission...

COVID-19 Telemedicine Services for Federal Employee Program Members

Audience: Physicians and Professional Health Care Providers

We would like to clarify cost-share information related to COVID-19 telemedicine services provided to members with coverage through the Federal Employee Program (FEP) during the COVID-19 state of emergency. FEP will waive the member cost-share for telemedicine...

Showing 1– 15 of 160 Results