Volume 15, 2009

Issue 41 - Claims Appeal Update
In an effort to improve provider satisfaction and provide an enhanced and more efficient claims experience we are pleased to announce significant changes to the claims appeal process.
Issue 40 - 2010 Behavioral Health Fee Update
Following careful consideration over the past several months, we are pleased to announce that the Behavioral Health fee schedule will increase by 2.94 percent in the aggregate effective January 15, 2010.
Issue 39 - 2010 Fee Schedule Update
Following careful consideration over the past several months, we are pleased to announce that our revised fee schedule for the separate rating region of Clinton and Essex Counties will become effective January 15, 2010.
Issue 38 - 2010 Fee Schedule Update
Following careful consideration over the past several months, we are pleased to announce that our revised fee schedule will become effective January 15, 2010.
Issue 37 - Renewing Behavioral Health Preauths
The following is important information for providers regarding the renewal of preauthorization for Behavioral Health services in the new year.
Issue 36 - NASCO Auto Accounts Claims to be Processed Through BlueCard
Effective January 1, 2010 claims for General Motors, Delphi, Ford, United Auto Workers (UAW) and American Axle groups submitted January 1, 2010 or later will be processed through the BlueCard® system.
Issue 35 - Respiratory Syncytial Virus
This bulletin contains important information regarding prophylactic treatment for high-risk patients.
Issue 34 - Durable Medical Equipment (DME) Update
Effective January 1, 2010 BlueShield will implement a revised reimbursement for HCPCS code E0570.
Issue 33 - Federal Mental Health Parity
Congress enacted the Pete Domenici and Paul Wellstone Mental Health Parity and Addiction Equity Act as part of the Emergency Economic Stabilization Act, which affects coverage of mental health and substance abuse services, on October 3, 2008.
Beginning October 30, 2009, any WNYHealtheNet registered user will automatically be registered to access www.bsneny.com.
Issue 31 - Recent Formulary Updates on Our Web Site
BlueShield of Northeastern New York is pleased to announce that we have updated our web site!
Issue 30 - New Prostate Biopsy Preauth Process
BlueShield of Northeastern New York is implementing a preauthorization program for prostate biopsies as part of an enhanced quality assurance process.
Issue 29 - Health Care Reform
As you know, health care reform is currently at the forefront of American domestic policy debate and it’s important that you know where BlueShield of Northeastern New York stands on this issue.
Issue 28 - Anesthesia for Upper and Lower Gastrointestinal Procedures
Effective September 1, 2009, BlueShield of Northeastern New York will require preauthorization for anesthesia services for diagnostic or therapeutic endoscopic procedures.
Issue 27 - Anesthesia for Upper and Lower Gastrointestinal Procedures
Effective September 1, 2009, BlueShield of Northeastern New York will require preauthorization for the use of anesthesia services or monitored anesthesia care (MAC) during gastrointestinal (GI) diagnostic or therapeutic endoscopy that is administered by an anesthesia provider.
Issue 26 - Sacroiliac Joint Arthrography and Injection
Effective September 1, 2009, the following CPT and HCPCS procedure codes will be considered Experimental/Investigational (EI) and will be indicated as such in the Code and Comment section on our web site.
Issue 25 - Affordability Update
Accelerating cost trends, as well as the economic recession and the unplanned increased New York State assessment on health insurers have resulted in significant impact on BlueShield of Northeastern New York.
Issue 24 - Billing Bilateral and Multiple-Unit Procedures
In accordance with Current Procedural Terminology (CPT) guidelines, bilateral procedures should be billed on one line only, utilizing the modifier 50; enter one as 01 in the units field and bill your total bilateral charge.
Issue 23 - Paperless Claims
To further enhance BlueShield of Northeastern New York’s Paperless Initiative and assist our providers in the submission of electronic claims, we are pleased to provide you with the following information.
Issue 22 - Credentialing and Recredentialing Through CAQH
Effective August 1, 2009, all providers not currently using CAQH will be required to enter their credentialing information (free of charge) into a secure, state-of-the-art data center.
Issue 21 - Pay for Performance Program Update
We are pleased to announce that we are making significant changes to our Physician Incentive Program effective July 1, 2009.
Issue 20 - Epidural Injections
Effective July 15, 2009, BlueShield of Northeastern New York will require preauthorization for all epidural injection procedures beyond the standard treatment of three injections within 12 months.
Issue 19 - Elective Cardiac Catheterization Preauthorization
To ensure the highest quality treatment in a cost-effective manner, BlueShield of Northeastern New York is implementing a preauthorization program to screen for the medical indications for elective cardiac catheterization.
Issue 18 - Manipulation Under Anesthesia
BlueShield of Northeastern New York will now require preauthorization for Manipulation Under Anesthesia (MUA) for procedures scheduled on or after July 15, 2009.
Issue 17 - Implantable Cardioverter Defibrillators
To ensure the highest quality treatment in a cost-effective manner, BlueShield is implementing a preauthorization program to screen for the medical indications for implantable cardioverter defibrillators.
Issue 16 - New Billing Guidelines for Home Infusion and Fee Schedule
New Billing Guidelines for Home Infusion, Enteral and Parenteral Therapies and Home Infusion Fee Schedule Effective July 1, 2009
Issue 14 - Oxygen and Oxygen-Related Supplies
Effective July 1, 2009, BlueShield of Northeastern New York will be implementing a revised reimbursement methodology for oxygen and oxygen-related supplies/services for all lines of business.
Issue 13 - Changes to Provider Call Center Hours of Operations
BlueShield of Northeastern New York Provider Service representatives will be available to answer your telephone inquiries Monday through Friday, from 8:30 a.m. to 12:00 p.m. and 1:00 p.m. to 5:00 p.m.
Issue 12 - Preauthorization Required for ED Procedures
Providers must report the applicable CPT/HCPCS/ICD-9 codes when requesting preauthorization or billing erectile dysfunction services for Healthy NY members.
Issue 11 - Never Events and Hospital Acquired Conditions
Effective October 1, 2008, BlueShield of Northeastern New York required a 'Present on Admission' (POA) value on all claim submissions from acute care hospitals.
Issue 10 - 2009 Paperless Initiative
BlueShield is pleased to announce that we are kicking off our 2009 Paperless Initiative.
Issue 09 - Office Based Surgery Accreditation
Effective July 14, 2009, BlueShield of Northeastern New York will adhere to the New York State Department of Health statute regarding office-based surgery accreditation.
Issue 08 - Focused Management of Medication
The following bulletin contains important information to assist providers with billing these services in an appropriate manner.
Issue 07 - Durable Medical Equipment Benefit Update
Effective March 1, 2009, some DME codes will be removed from the Prior Authorization Required Guide for our members.
Issue 06 - Home Health Aide Prior Authorization Removed
Effective March 1, 2009, Home Health Aide (HHA) services will no longer require prior authorization for our members, with the exception of Healthy NY and select Administrative Services Only (ASO) contracts.
Issue 05 - Revised Fee Schedule for Orthotic and Prosthetic Codes
Effective March 1, 2009, we will implement reimbursement of HCPCS “L” codes based on the Medicare-based methodology of January 1, 2008.
Issue 04 - Prior Authorization Requirement for Cervical / Lumbar Fusion Surgery
Effective March 1, 2009, cervical and lumbar fusion surgeries will require prior authorization to determine medical necessity. InterQual guidelines are utilized in making medical necessity determinations.
Issue 03 - Physical and Occupational Therapy Reimbursement Update
As a reminder, reimbursement continues to be paid by service encounter, not by individual modality or treatment, for Physical and Occupational Therapy services.
Issue 02 - Hospital Inpatient Preauthorization Requirement Removed
In an effort to further reduce the administrative burdens placed on our providers, we are pleased to announce that effective February 15, 2009, facilities will no longer be required to obtain prior approval for admissions.
Issue 01 - Inpatient Preauthorization Requirement Removed
In an effort to further reduce the administrative burdens placed on our providers, we are pleased to announce that effective February 15, 2009, providers will no longer be required to obtain prior approval for inpatient admissions.