Audience: Professional Providers, Hospitals and Skilled Nursing Facilities
Excellus BlueCross BlueShield (BCBS) has implemented the requirements included in Governor Hochul’s Executive Order #4, issued September 27, 2021 for its fully insured members. In addition, Excellus BCBS has extended these requirements to its Medicare line of business.
The terms of Executive Order #4 are not being extended to the Federal Employee Program (FEP) or to self-funded accounts that have not elected to apply the terms of Executive Order #4.
Pursuant to Executive Order #4, hospitals must certify that the suspension of utilization review requirements is necessary to increase the availability of health care staff. Here is a copy of the - NYS-approved certification form and instructions. Please submit a copy of the completed form to Provider.Relations@excellus.com.
The requirements of Executive Order #4 are summarized below, but we encourage you to review the document in its entirety for additional information.
Beginning September 27, 2021 and through October 27, 2021 (end date subject to extension), the following provisions are in place:
Suspension of Certain Utilization Review Requirements (Certification form required by NYS)
- Suspension of preauthorization requirements for scheduled hospital surgeries and admissions, hospital outpatient services, home health care services following a hospital admission and inpatient and outpatient rehabilitation services following a hospital admission. Hospitals are strongly encouraged to provide notification to us within 48 hours of an admission to aid in discharge planning and coordination of care.
- Suspension of concurrent review for inpatient and outpatient hospital services and retrospective reviews for in-network inpatient and outpatient hospital services. Home care services may be reviewed concurrently and retrospectively. The Health Plan will resume retrospective reviews as of October 28, 2021, if the end date of Executive Order #4 is not extended by NYS.
- Tolling of the time frame for submitting internal and external appeals.
Additional Provisions: In an effort to further alleviate the impact of the health provider shortage at hospitals and other facilities, Executive Order #4 also expanded the scope of practice for various types of providers. Please notify us if you add any of the following provider types to your staff, which will assist in facilitating timely claims processing and payment.
- Allow out of state/out of country health care workers to practice care (physicians, RNs, LPNs, NPs, PAs, midwives, clinical nurse specialists, LMSWs and LCSWs).
- Allow physician visits in nursing homes via telehealth.
- Allow emergency medical technicians (EMTs) and advanced EMTs to practice and assist in additional settings. Also allow EMTs to vaccinate and test for COVID-19.
- Allow NYS-licensed providers without current registrations to practice without penalty for lack of registration.
- Allow midwives, registered nurses, physicians, and nurse practitioners to more easily administer and order COVID-19 vaccinations and testing and flu vaccinations and testing.
If you have any questions, please contact your Provider Relations representative.Email this article