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Coverage Exclusion of Non-FDA Approved Medications for Commercial, Exchange, Essential Plan, and Child Health Plus Members

Audience: Providers of impacted patients

We have identified several medications on our formularies that are non-FDA approved products. As a result, beginning April 1, 2021, we will remove these medications from the respective formularies and exclude coverage for the following medications: Hydrocortisone...

Telemedicine and Telehealth Administrative Policy 22 Part II Effective May 24, 2021

Audience: All Providers

Excellus BlueCross BlueShield is implementing the following administrative policy effective May 24, 2021, to define the coverage and billing guidelines for Telemedicine and Telehealth Part II billed by providers contracted to provide this service. You can access the...

Certain Continuous Glucose Monitoring Systems Available at Retail Pharmacy

Audience: Providers of impacted patients

Continuous Glucose Monitoring Systems (CGMS) are a medical benefit that previously required a Durable Medical Equipment (DME) provider for processing.  We are notifying you that we have made recent changes that now allow certain CGMS products to process at a retail...

COVID-19 Vaccine Effort – Volunteer Information

Audience: Physicians, Hospitals and Facilities

Supporting our communities is a big part of who we are as a company, and donating our time is one way we can help lessen the impact of COVID-19. We have encouraged those who’d like to help with vaccination efforts to sign up through New York State’s Volunteer Program...

Neulasta® Onpro Coverage Requirements for Medicaid Managed Care and Child Health Plus members

Audience: Providers of impacted members

This notice is to remind our providers that Neulasta® Onpro requires prior authorization for Medicaid Managed Care and Child Health Plus members. Existing policy criteria requires use of the biosimilar Udenyca as the preferred pegfilgrastim therapy. Beginning February 1,...

Patient Access to Health Information via Third-Party App

Audience: All Providers

As of January 1, 2021, most health insurance plans are required to provide their members with access to their health information through a patient access application programming interface (API).   This new requirement allows members the option of downloading...

Utilization Management Program-Preauthorization Update Effective May 1, 2021 for All Lines of Business that Require Preauthorization

Audience: all providers

We would like to share updates with you 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...

Upcoming HEDIS® Medical Record Review for Out-of-Area Members

Audience: All Providers

We would like you to be aware of an upcoming medical record retrieval initiative in support of the Healthcare Effectiveness Data and Information Set (HEDIS). Excellus BlueCross BlueShield has engaged an independent company, Inovalon, Inc. (Inovalon), to collect...

New Dental Record Requirements Grid Available Online

Audience: Participating Dental Care Providers

We are excited to share with you that we have a new grid available on our website to help you determine when we require dental records to consider or approve a claim for payment. The Procedure Codes that Require Dental Record Submission grid includes information on the...

COVID-19 Treatment with Monoclonal Antibodies

Audience: Physicians, Hospitals, Infusion Centers, Skilled Nursing Facilities and Home Health Care Providers

The U.S. Food and Drug Administration issued an emergency use authorization for investigational monoclonal antibody therapies bamlanivimab and casirivimab/imdevimab for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adult and pediatric patients. ...

Inflectra Preferred Therapy for Medicare Advantage Members

Audience: Par specialty providers that prescribe Infliximab products

Our updated 2018 infliximab drug policy names the biosimilar Inflectra as the preferred infliximab product for all lines of business (Commercial, Exchange, Essential Plan, Child Health Plus and Medicaid Managed Care) except Medicare Advantage. Since the policy update, of...

Preauthorization, Notice Requirements from NYS DFS Insurance Circular Letter #17

Audience: Hospitals, Inpatient Mental Health Facilities, Skilled Nursing Facilities, Home Health Care Providers

Excellus BlueCross BlueShield (BCBS) has implemented the requirements included in the New York State Department of Financial Services’ (NYS DFS) Insurance Circular Letter No. 17 (2020) issued December 23, 2020 for its commercial and Safety Net lines of business. In...

Update to Administrative Policy AP-26 COVID-19 Viral and Antibody Testing and Supplies – Diagnosis Code B97.29

Audience: Physicians, Hospitals, Facilities and Laboratories

Administrative Policy AP-26 COVID-19 Viral and Antibody Testing and Supplies has been updated  for claims billed on or after February 1, 2021, to remove interim diagnosis code B97.29 (Coronavirus as the cause of diseases classified elsewhere).  This update...

Polycarbonate Lenses Coding Update for CHP, MMC and HARP Members

Audience: Participating Vision Care Providers

We would like to make you aware of an update to the polycarbonate lenses procedure code for Child Health Plus (CHP), Medicaid Managed Care (MMC), and Health and Recovery Plan (HARP) members. This applies to our members with Child Health Plus, HMOBlue Option, Blue Choice...

New Dental Products Effective January 1, 2021

Audience: Participating Dental Care Providers

We would like to make you aware of three new dental products effective January 1, 2021. These new products are dental-only plans that have no ties to a member’s medical plan. These standalone dental plans are different from embedded dental plans, which provide some dental...

Showing 1– 15 of 135 Results