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Extension of In-Network Outpatient Behavioral Health Services for Essential Workers During the COVID-19 State of Emergency
Audience: Behavioral Health Providers and Outpatient FacilitesOn November 27, 2020, the New York State Department of Financial Services issued an extension of its emergency regulation and circular letter, which was set to expire on November 27. The regulation waives member cost-share for outpatient mental health services provided to...
Administrative Policy AP-26 – COVID-19 Viral and Antibody Testing and Supplies; Reimbursement Update Effective March 1, 2021
Audience: Physicians and FacilitiesWe advise you that Excellus BlueCross BlueShield Policy AP-26 COVID-19 Viral and Antibody Testing and Supplies will be updated effective March 1, 2021, to define the coverage, reimbursement and billing guidelines for COVID-19 testing. You can access the individual...
Extension of Member Cost-Share Waiver for COVID, non-COVID Telehealth Services
Audience: Professional Providers and Certified Home Healthcare AgenciesMember 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 HospitalsYour 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 LaboratoriesWe 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 FacilitiesIt 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 HospitalsWe 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 DentistsAs 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 MidwivesAs 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 FacilitiesWe 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 ProvidersWe 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 TherapistsPlease 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: HospitalsEffective 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 facilitiesExcellus 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 providersOur 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...
