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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...

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...

COVID-19 Vaccine Information and Updates to Administrative Policy 15

Audience: Physicians, Nurse Midwives, Hospitals and Facilities

To ensure that you are ready to order, receive and administer the COVID-19 vaccine as it becomes available, please refer to the New York State Department of Health (NYS DOH) website and the Governor’s news page for information and resources critical to enrolling in the...

Locating 2020 Authorizations in CareAdvance Provider® Tool

Audience: Participating Physical Therapists

If you are unable to locate an existing 2020 physical therapy authorization in CareAdvance Provider, send an email to CAPAdministrator@excellus.com. Please include your NPI, the patient’s name and date of birth, and the case number if you have it. We will reopen the case...

Utilization Management Program-Preauthorization Update Effective February 1, 2021

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...

Picato Gel Discontinued

Audience: Providers of impacted patients

Drug manufacturer LEO Pharma Inc. has voluntarily withdrawn Picato® gel (ingenol mebutate) from the market in order to focus on producing other dermatological drugs.  A list of your patients who may have filled a prescription for Picato over the last four months is...

Updated Administrative Policy 30—Billing and Reimbursement Guidelines for Antigen Preparation for Allergy Immunology Effective January 1, 2021

Audience: Allergy and Immunology providers

Excellus BlueCross BlueShield is updating its administrative policy for antigen preparation for allergy immunotherapy effective January 1, 2021. You can access the individual policies by clicking here. Note: You must login with your username and password to access our...

COVID-19 Reinstating Reimbursement of Preventive Visits via Telehealth

Audience: Primary Care Physicians and Nurse Practitioners

Excellus BlueCross BlueShield is steadfast in its commitment to ensuring continuity of care for our members during the COVID-19 public health emergency. Due to the recent surge in COVID-19 cases in the communities that we serve, we will reinstate reimbursement for...

Physical, Occupational, and Speech Therapy Preauthorization Process Change Effective January 1 2021

Audience: Primary Care Physicians and Physical, Occupational and Speech Therapists

We remind you that effective January 1, 2021, Excellus BlueCross BlueShield will require preauthorization for all physical, occupational and speech services requested for our members who have Medicaid Managed Care and Health and Recovery Plan (HARP) coverage. This...

Showing 1– 15 of 139 Results