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Extension of Member Cost-Share Waiver for COVID, non-COVID Telehealth Services

Audience: Professional Providers and Certified Home Healthcare Agencies

Member Cost-Share for Telehealth Services  For Medicare Advantage members, we will continue to cover both COVID-19 and non-COVID-19 related telehealth services with no member cost-share through the end of the public health emergency, currently set to expire...

Coding Guideline Changes for Outpatient Hospital Facilities Effective January 1, 2021

Audience: Participating Hospitals

Your opinions and suggestions are very important to us. As the result of the suggestions that we received regarding the upcoming coding guideline changes communicated in our bulletin issued October 9, 2020, additional revenue codes will be removed from the CPT/HCPCS...

Modifier CG Clarification for COVID-19 Viral and Antibody Testing

Audience: Participating Physicians, Hospitals, Facilities and Laboratories

We would like to clarify the use of modifier CG (policy criteria applied) when submitting claims for COVID-19 viral and antibody testing. This applies to all Health Plan products and lines of business. Modifier CG (or one of these diagnosis codes - Z02.0, Z02.1, Z02.4,...

Telehealth Claims Billed with Modifier 95 – Processing Error

Audience: Behavioral Health Providers and Outpatient Facilities

It has come to our attention that telehealth claims billed with modifier 95 for dates of service beginning October 15, 2020, have been paid based on an incorrect fee schedule due to an internal error. Be assured that we are working on this issue and it will be corrected...

Update to Prepayment Review of Institutional Inpatient BlueCard® Claims

Audience: Participating Hospitals

We would like to make you aware that the threshold for institutional inpatient BlueCard claims requiring prepayment review is being reduced from $200,000 to $100,000. Effective January 1, 2021, these claims received from participating acute-care providers with a total...

No Coverage for CPT Code 99072, Personal Protective Equipment

Audience: Participating Physicians and Dentists

As we have previously communicated, the Health Plan does not reimburse for personal protective equipment, supplies, or materials, as they are considered inclusive to the service provided. This includes non-coverage of CPT code 99072, used to bill for additional supplies,...

Bright Beginnings Prenatal Incentive Program

Audience: Physicians and Nurse Midwives

As you may know, we provide an incentive to participating physicians and nurse midwives providing prenatal care to members enrolled in “Safety Net” (Child Health Plus, HMOBlue Option, Blue Choice Option, Premier Option, and Premier Child Health Plus) products through our...

Administrative Policy AP-26 – COVID-19 Viral and Antibody Testing; Reimbursement Update Effective January 21, 2021

Audience: Physicians and Facilities

We advise you that Excellus BlueCross BlueShield Policy AP-26 COVID-19 Viral and Antibody Testing will be updated effective January 21, 2021, to define the coverage, reimbursement and billing guidelines for COVID-19 testing. You can access the individual policies by...

New Payment Process Effective November 20, 2020

Audience: All Participating and Non-Participating Providers

We are pleased to announce that Excellus BlueCross BlueShield has partnered with Zelis® Payments, an independent company and will be offering ePayment options that can accelerate the settlement of claim payments. This service will be available for all lines of...

Helpful Reminders for the 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 the...

Coding Guideline Changes for Outpatient Hospital Facilities Effective January 1, 2021

Audience: Hospitals

Effective January 1, 2021, Excellus BlueCross BlueShield will require CPT/HCPCS codes to be billed with most revenue codes billed on UB-04 type of bill 013X.  A summarized list of revenue codes that require CPT/HCPCS coding is enclosed.  The full, detailed list...

Utilization Review for Inpatient Rehabilitation Services Effective January 1

Audience: Hospitals, skilled nursing facilities

Excellus BlueCross BlueShield would like you to be aware of an upcoming reduction in the allowed time frame health plans will have to make preauthorization determinations and provide written and verbal notice for inpatient rehabilitation services provided by a skilled...

Check eMedNY for MMC and HARP Members

Audience: All providers

Our claims processing system will be continuously updated to reflect CPT® codes that are not covered benefits for Medicaid Managed Care (MMC) and Health and Recovery Plan (HARP) members per the Medicaid eligibility verification system, eMedNY.org. This applies to our...

Extension of Cost-Share Waiver for In-Network Outpatient Behavioral Health Services for Essential Workers to Nov. 27

Audience: Behavioral health providers and facilities

On September 29, 2020, the New York State Department of Financial Services issued an extension of its emergency regulation and circular letter, which waives member cost-share for outpatient mental health services provided to essential workers during the COVID-19 state of...

Diabetic Step Therapy Update for 2021

Audience: Providers of impacted patients

We would like you to be aware of an upcoming policy update involving select diabetic prescription medications listed in the table below. Starting January 1, 2021, step therapy requirements for these medications will apply to new and existing users under our commercial...

Showing 1– 15 of 134 Results