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Extension of Cost-Share Waiver for In-Network Outpatient Behavioral Health Services for Essential Workers to Nov. 27

Audience: Behavioral health providers and facilities

On September 29, 2020, the New York State Department of Financial Services issued an extension of its emergency regulation and circular letter, which waives member cost-share for outpatient mental health services provided to essential workers during the COVID-19 state of...

Diabetic Step Therapy Update for 2021

Audience: Providers of impacted patients

We would like you to be aware of an upcoming policy update involving select diabetic prescription medications listed in the table below. Starting January 1, 2021, step therapy requirements for these medications will apply to new and existing users under our commercial...

Utilization Management Program-Preauthorization Updates Effective November 1, 2020

Audience: All Providers

We would like to share updates with you regarding preauthorization under our Utilization Management (UM) Program and application of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) for Medicare Advantage.  The UM Program gives...

HEDIS® Specification Updates

Audience: All Physicians

Excellus BlueCross BlueShield would like to make you aware of some important updates to the HEDIS measures that were released on July 1, 2020, from the National Committee for Quality Assurance (NCQA). The updates are for the measurement year 2020 (January 1, 2020 –...

Cost-Share Update for RIT Members Related to Non-COVID-19 Telehealth Services

Audience: Rochester Region Providers

This information replaces our July 24, 2020 communication regarding member cost-share for           non-COVID-19-related telehealth services for Rochester Institute of Technology (RIT) members.  Non-COVID-19-related telehealth services for...

Thyroid Medication Recall: NatureThroid and WP Thyroid

Audience: Providers of impacted patients

RLC Labs, Inc. is voluntarily recalling Nature-Throid® and WP Thyroid® in all strengths, all counts of product within current expiry to the consumer level. The products are being recalled because testing of samples from six (6) lots by the U.S. Food and Drug...

Member Cost-Share Waiver Update for COVID, non-COVID Telehealth Services

Audience: Professional Providers, Hospitals and Certified Home Healthcare Agencies

Please review the important updates below related to our extension of the member cost-share  waiver and continued provider reimbursement for COVID-19 and non-COVID-19 telehealth services.  We will continue to monitor the federal public health emergency and the...

Updates to Administrative Policy-15 Part III: Evaluation & Management and Vaccine Administration Effective December 17, 2020

Audience: All Physicians

Excellus BlueCross BlueShield is updating Administrative Policy-15 to include a new Part III effective December 17, 2020, to define billing and reimbursement guidelines. You can access the individual policies by clicking here. Note: You must login with your username and...

Physical, Occupational, and Speech Therapy Preauthorization Process Change

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

We would like you to be aware 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)...

Intensity Modulated Radiation Therapy for Prostate Cancer Update

Audience: Radiation Oncologists

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...

Medicare Advantage Changes Effective January 1, 2021

Audience: All Providers and Facilities

We would like you to be aware of the following benefit and administrative changes effective January 1, 2021 for our members who have Medicare Advantage coverage. Members will be notified of these changes in September. The Annual Enrollment Period (AEP) extends from...

Reminder: Updates to New Administrative Policy Effective October 1, 2020

Audience: Optometrists

On June 22, 2020, Excellus BlueCross BlueShield notified you of the implementation of Administrative Policy 34 – Optometry Scope of Practice (“AP-34”) effective October 1, 2020, to define the billing and reimbursement guidelines for certain surgical codes for eye and...

You are Invited! CareAdvance Provider® Authorization Tool WebEx

Audience: Providers

Are you familiar with CareAdvance Provider, our new web-based authorization tool that is available for authorizations?  If not, we’re here to help! Join us for one of the following informational WebEx presentations: Wednesday, September 16 at 11 a.m. Tuesday,...

Requesting Additional Visits in CareAdvance Provider® Tool

Audience: Physical, Occupational, and Speech Therapists and home care providers

Please 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...

Prohibition on Billing our Members for Personal Protective Equipment (PPE)

Audience: Medical and Dental Service Providers

On August 5, 2020, the New York State Department of Financial Services (“DFS”) issued Circular Letter No. 14 (2020) regarding charges for personal protective equipment (“PPE”) by health care and dental care providers. The Circular Letter addresses complaints received from...

Showing 31– 45 of 139 Results