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Durable Medical Equipment (DME) Online Resources

Audience: DME Providers

Our website contains several resources that we recommend you use prior to issuing durable medical equipment to our members and submitting claims. DME Rental / Purchase Grid A DME rental vs. purchase grid is available to assist you in determining the codes with...

Medical Utilization Management Program Updates Effective June 1, 2020

Audience: Providers and Facilities

NOTE: Preauthorization will be added to codes for HMOBlue Option, Blue Choice Option, Premier Option, Blue Option Plus, Premier Option Plus, Child Health Plus, Premier Child Health Plus and the Essential Plan effective June 1, 2020. Additional details are included...

Web Self-Service Reminders for Outsourced Billing Agencies

Audience: Provider Office Billing Agencies

Web access is available to your billing agency so that it can check member eligibility, benefits and claim status, 24 hours a day, seven days a week.   To authorize a representative from your billing agency to access the secure area of our website to check claims...

Requesting Additional Units Using CareAdvance Provider® Tool

Audience: Durable Medical Equipment Providers

We would like to provide clarification regarding the new process for requesting additional units for Durable Medical Equipment through our new CareAdvance Provider online authorization tool. If you have an authorization that was entered originally using our Clear...

CareAdvance® Provider Preauthorization Tool Expansion to Medicare and Commercial Lines of Business

Audience: All Providers

We announced previously that our new electronic preauthorization system, CareAdvance Provider, would be introduced in phases beginning with the Safety Net line of business on February 3, 2020. We would now like to provide you with advance notice regarding the transition...

Correct Coding in CareAdvance Provider® Preauthorization Tool

Audience: Physical Therapy, Occupational Therapy and Home Care providers

We remind you that the same coding rules that applied in the Clear CoverageTM authorization tool also apply when requesting authorization in our new CareAdvance Provider tool. Please help us to process your authorization request correctly and efficiently by applying the...

Requesting Additional Visits for Essential Plan Members

Audience: All Providers

We would like to provide clarification regarding the new process for requesting additional visits for our Essential Plan members due to our transition to the new CareAdvance Provider® authorization tool. If you have an authorization that was entered originally using our...

CareAdvance Provider® Preauthorization Tool Reminder and Tips

Audience: All Providers

We remind you that our new CareAdvance Provider online authorization tool should now be used when requesting preauthorization for our Safety Net members. This includes Medicaid Managed Care (HMOBlue Option, Blue Choice Option, Premier Option), Child Health Plus and...

Clarification – Medical Utilization Management Program Updates for Safety Net Members Effective January 17

Audience: All providers, facilities, hospitals

Our bulletin issued December 10, 2019, notified you that preauthorization requirements for some services would be lifted effective January 17, 2020. In addition, be advised that preauthorization is NOT required for Safety Net members for the following codes shaded in gray...

Invokana and Invokamet Removed from MMC Formulary

Audience: Providers of Impacted Members

All Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors are indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes and offer similar glycemic efficacy.  Available treatment guidelines do not prefer one SGLT2 inhibitor over...

Certain Insulin Medications Removed from CHP Formulary

Audience: Providers of Impacted Members

We would like you to be aware that we will no longer provide coverage for Admelog®, Apidra®, Fiasp® and Novolog® under our prescription drug formulary for members with Child Health Plus. This change is effective March 15, 2020 We have notified members who filled a...

Essential Plan Administrative Change

Audience: All Providers

Excellus BlueCross BlueShield advises you of an important upcoming change that pertains to our Essential Plan product. Effective February 3, 2020 Please use the following contact numbers for services provided to our Essential Plan members: *Includes requests for the...

Important Details Regarding CareAdvance Provider® Tool Launching February 3

Audience: All Providers

Our new electronic preauthorization system — CareAdvance Provider, is scheduled to be ready for use February 3, 2020, for requesting preauthorizations for the Safety Net line of business. This includes:  Medicaid Managed Care (HMOBlue Option, Blue Choice Option,...

Clinical Updates for Select Diabetic Prescription Medications

Audience: Participating Physicians

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, 2020, step therapy requirements for these medications will apply to new and existing users under our commercial...

ProgenyHealth Neonatal Intensive Care Program Update and Reminders

We would like you to be aware that our Neonatal Intensive Care Program in partnership with ProgenyHealth, Inc., an independent company, will soon be available to an additional number of our members, some of whom may be your patients. As always, be sure to check member...

Showing 106– 120 of 139 Results