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Latest News

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...

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Administrative Policy effective January 1, 2020

Excellus BlueCross BlueShield will implement a new administrative policy entitled “Related Services” effective January 1, 2020, for all lines of business. The Health Plan will not cover services deemed to be related to a noncovered surgical service, based on the criteria...

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MMC Ovulation Enhancing Drugs Prior Authorization Effective December 1

Medicaid Managed Care plan benefits now cover some ovulation-enhancing drugs for individuals ages 21 through 44 experiencing infertility. The following ovulation enhancing drugs will be covered and will be limited to three cycles of treatment per lifetime: ...

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InterQual® Criteria 2019 Update

Our Health Plan uses nationally recognized criteria, including InterQual, to determine appropriateness of care for our members.  We would like you to be aware that effective October 15, 2019, we will adopt the 2019 clinical revisions to InterQual criteria, which...

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Modifier “AT” Required for Some CPT Codes Effective January 1, 2020

We currently require the use of modifier “AT” (acute or active treatment) when billing current procedural terminology (CPT) codes 98940, 98941 and 98942 for chiropractic services provided to our Medicare Advantage members, pursuant to the Centers for Medicare &...

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Qualified Medicare Beneficiary Member Billing Update

Excellus BlueCross BlueShield reminds you that under federal law, any member cost sharing resulting from services provided to a Qualified Medicare Beneficiary (QMB) must be billed to Medicaid. QMB members, who are those eligible for both Medicare and Medicaid, cannot be...

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Customer Care Department Closed for Training on October 14

On October 14, 2019, our Customer Care provider phone lines will be closed to allow for staff training and development.  Our Medical Intake Customer Care line will remain open with minimal staff available for urgent preauthorization requests. You may reach...

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Notification Reminder for Children’s Home and Community Based Services Carved into Medicaid Managed Care

Excellus BlueCross BlueShield (“Health Plan”) is requesting notification upon the initiation of Children’s Home and Community-Based Services (HCBS), in accordance with the New York State’s Children’s Waiver HCBS Plan of Care Workflow.  For details, please refer...

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Diabetic Retinopathy Documentation Reminder

Dear Eye Care Specialist: Excellus BlueCross BlueShield is collaborating with primary care providers (PCPs) across our service area to promote diabetic eye exams as a means for addressing the nation’s dramatic increase in diabetic retinopathy in recent years. We need...

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Medicare Advantage Dental Supplemental Benefits

Starting January 1, 2020, we will be offering Dental Optional Supplemental Benefits to our direct pay Medicare Advantage members. Please call Customer Care to verify the member’s eligibility. What’s New: There are no waiting periods for covered services. ...

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Medical Utilization Management Program Updates Effective January 1, 2020

We would like to share a general overview regarding our upcoming standard medical Utilization Management (UM) Program updates. The updates are effective for requests beginning January 1, 2020 ; however, we want to provide you with ample notification to enable you to...

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Clinical Editing Policy Update – Multiple Endoscopy

Our bulletin issued May 31, 2019 advised you that we would implement the Centers for Medicare and Medicaid Services multiple endoscopy policy effective for dates of service on or after September 2, 2019 for all lines of business. Implementation of this policy has been...

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Correct Billing Codes for Makena

We have recently received quite a few questions about Makena (Hydroxyprogesterone Caproate [HPC]) and correct billing procedures, and we are here to help! Please review the information below for some helpful billing guidelines for Hydroxyprogesterone Caproate (HPC). ...

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Reminder — Limited Medicaid Coverage of Infertility Drugs Effective October 1

We remind you that effective October 1, 2019, members enrolled in Medicaid Managed Care (MMC) products (i.e., HMOBlue Option, Blue Choice Option and Premier Option) or the Health and Recovery Plan (HARP) product (i.e., Blue Option Plus and Premier Option Plus) will have...

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New Electronic Preauthorization Tool Coming Soon

We would like to provide you with advance notice of our new electronic preauthorization system — CareAdvance Provider®, a web-based real-time software tool. CareAdvance Provider will replace our current tool, Clear CoverageTM. The new tool will be introduced in...

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Showing 1– 15 of 173 Results