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Latest News

Medical Utilization Management Program Updates Effective January 17, 2020

We would like to share an overview with you regarding our standard medical Utilization Management (UM) Program updates effective for requests beginning January 17, 2020 . These updates will be posted to Provider.ExcellusBCBS.com on December 15, 2019 . For services...

Billing Update for Urinalysis Drug Testing

We would like to provide you with advance notice of a coverage update related to HCPCS code G0480 (urinalysis - drug testing). This update is in line with billing guidance from the Centers for Medicare & Medicaid Services and pertains to New York state government...

Reminder - NYS Legislation for Maternal Depression Screening Effective August 11, 2019

We would like to remind you of a New York state mandate effective August 11, 2019 that expands coverage for maternal depression screening services for some members enrolled in commercial and exchange lines of business. Screening for maternal depression is a covered...

NYS Legislation for Coverage of In-Vitro Fertilization & Fertility Preservation Services

We would like you to be aware of a New York state mandate effective January 1, 2020, upon group renewal that expands coverage for in-vitro fertilization (IVF) and fertility preservation services. The mandate applies to commercial and exchange lines of business. The...

Ranitidine Recall for Dr. Reddy’s Laboratories

Dr. Reddy’s Laboratories Ltd.  confirms it had initiated a voluntary nationwide recall on October 1, 2019 (at the retail level for over-the-counter products and at the consumer level for prescription products) of all its ranitidine medications sold in US due to...

Reminder – Erectile Dysfunction Procedure Preauthorization Requirement

We remind you that a 2007 New York state mandate excludes coverage of erectile dysfunction treatment for members enrolled in Medicaid Managed Care (HMOBlue Option, Blue Choice Option and Premier Option) and Health and Recovery Plan products (Blue Option Plus and Premier...

Dental FEP Can Send Claims Electronically Through Tesia

We have good news! Starting November 1, 2019 , Excellus BlueCross BlueShield is accepting dental FEP claims electronically through our vendor partner, Tesia Clearinghouse, LLC (Tesia). You can identify any FEP member by the standard BCBS Federal Program Logo on the...

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 Coverage TM . We would now like to provide an update regarding the implementation time frame...

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...

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...

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: ...

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...

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 &...

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...

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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