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Preauthorization Updates Effective May 1, 2022 for All Lines of Business Requiring Preauthorization

Audience: All Providers

We would like to share updates regarding preauthorization under our Utilization Management (UM) Program. The UM Program gives Excellus BlueCross BlueShield and its health care provider partners the opportunity to monitor medical episodes of care to prevent unnecessary...

AP-42 – Developmental and Psychological Testing Policy Effective March 1

Audience: Professional Providers

Excellus BlueCross BlueShield is implementing the following administrative policy effective March 1, 2022 to define coverage and billing guidelines for developmental and psychological testing billed by providers contracted to provide this service. You can access the...

Utilization Management Updates for Cardiology Imaging Services Only

Audience: Cardiologists and Radiologists

We would like to make you aware of a delay in the effective date for utilization management updates for cardiology imaging services.  In our communication dated October 28, 2021, we shared an effective date of February 1, 2022; that implementation is on pause for...

Information Related to NYS DFS Insurance Circular Letter No. 1 (2022)

Audience: Hospitals and Skilled Nursing Facilities

Excellus BlueCross BlueShield (BCBS) has implemented the requirements included in the New York State Department of Financial Services’ (NYS DFS) Insurance Circular Letter No. 1 (2022) issued January 6, 2022, for its commercial and Safety Net lines of business. In...

Assisted Reproductive Technologies – In Vitro Fertilization Medical Policy Update Effective April 14, 2022

Audience: OB/GYNs and Endocrinologists

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are...

New Clinical Editing Policy Effective April 1, 2022

Audience: All Professional Providers

Excellus BlueCross BlueShield is implementing a clinical editing policy effective April 1, 2022, which will no longer provide reimbursement for codes that have a Centers for Medicare and Medicaid Services (CMS) status indicator. The policy, which is in line with CMS...

Telehealth Payment Parity Update

Audience: All Participating Providers

With the pandemic still a reality in our day-to-day lives, we want our members to have the peace of mind that comes from knowing they can still receive care in the comfort and safety of their homes through the use of telehealth technology. We also know how important it...

Holiday Office Closure and Zelis® Payments Schedule Update

Audience: Participating Providers and Facilities

Excellus BlueCross BlueShield offices will be closed on December 24, 2021. There will be no pay cycle schedule changes for InstaMed®. There will be delays in the transmission of paper checks issued by Zelis Payments. Please allow for delivery time via the U.S. Postal...

Clinical Editing Reminder: Multiple Procedure Payment Reduction Rules

Audience: Participating Providers

Excellus BlueCross BlueShield follows the Centers for Medicare and Medicaid Services (CMS) Multiple Procedure Payment Reduction rules for all lines of business. When multiple surgeries or procedures are performed by a single physician, or when physicians in the same group...

New Radiation Oncology Medical Policy Effective March 15, 2022

Audience: Radiologists and OB/GYNs

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are...

Update to Radiation Oncology Medical Policy Effective March 15, 2022

Audience: Participating Oncologists: Radiation, Medical, and Surgical

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are...

Updated Participating Provider Manual Now Available

Audience: Participating Physicians, Health Care Practitioners and Facilities

The Excellus BlueCross BlueShield Participating Provider Manual has been updated and is now available on our website. You will need to log in to the secure portion of the website to view the manual. Once logged in, you now have the option to view the entire manual or the...

2022 Authorization Requests

Audience: Physical, Occupational, and Speech Therapists and Home Care Providers

New authorization requests for physical, occupational, speech and home care services in 2022 can be entered into the CareAdvance Provider® tool beginning December 20, 2021. Please share this information with anyone in your practice who needs to be aware. If you have...

Federal Employee Program Preauthorization Requirements for Kidney Transplants

Audience: Surgeons, Nephrologists and Hospitals

Effective January 1, 2022, the Federal Employee Program (FEP) will require preauthorization for kidney transplants for all FEP plans. Kidney transplants will also become part of the Blue Distinction Centers for Transplants Program as of January 1. The FEP Medical Policy...

Submission of Claims Requiring Medical Records

Audience: All Providers

In accordance with standard medical record submission procedures, Excellus BlueCross BlueShield requires medical records related to certain services be filed with the initial claim. Effective March 15, 2022, we will begin returning records related to these specific...

Showing 1– 15 of 113 Results
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