Volume 18, 2012

Issue 33 (a) 2013 Fee Schedule Update
Effective April 1, 2013, the BlueShield of Northeastern New York Standard Commercial Fee Schedule will be updated.
Issue 33 (b) 2013 Fee Schedule Update
Effective April 1, 2013, the BlueShield of Northeastern New York Standard Commercial Fee Schedule will be updated.
Issue 32 - Policy Reminder for Imaging Providers
This is a reminder that the imaging moratorium remains in effect.
Issue 31 - Transition of Benefits Administration
Effective January 1, 2013, BlueShield of Northeastern New York will administer the wellness benefits for our members.
Issue 30 - Diabetes Treatment Intervention
BlueShield of Northeastern New York wants to help improve outcomes for Medicare Advantage and Medicare Prescription Drug Plan patients with diabetes.
Issue 29 - Chiropractic Transition
As a reminder, effective January 1, 2013, BlueShield of Northeastern New York will administer the chiropractic benefits for our members.
Issue 27 - Drug Therapy Guideline Updates Available on our Website
As a result of the annual guideline review and new drug evaluations performed quarterly by our Pharmacy and Therapeutics Committee, the enclosed updated Drug Therapy Guidelines will be effective as of December 15, 2012.
Issue 26 - NYS Mandate Annual Physical
New York state recently passed a law requiring insurance companies to allow one routine physical exam or one well-care visit per calendar year.
Issue 25 - Genetic Testing for Inherited Thrombophilia
We want to keep you updated about a medical protocol that will be effective soon.
Issue 24 - Important Durable Medical Equipment, Prosthetic, and Orthotic Information
We are updating our Durable Medical Equipment (DME) and Orthotic and Prosthetic fee schedules for 2013.
Issue 23 - Medco to Change Name to Express Scripts
Effective September 1, 2012, Medco® will be Express Scripts®.
Issue 22 - Drug Therapy Guideline Updates Available on our Website
As a result of the annual guideline review and new drug evaluations performed quarterly by our Pharmacy and Therapeutics Committee, the enclosed updated Drug Therapy Guidelines will be effective as of September 15, 2012.
Issue 21 - Radiation Therapy Clinical Guidelines Update
Radiation Therapy Clinical Guidelines have been updated and will be effective September 1, 2012.
Issue 20 - Decreasing Hospital Readmissions through Care Coordination
We have developed our third Patient-Centered Medical Home (PCMH) incentive: Care coordination of patients after inpatient hospitalization.
Issue 19 - Provider Data Update Requirement
During a standard review of provider files, it was discovered that you are listed under a group practice instead of as a solo practitioner.
6676_Ancillary_Provider_Claims
In order to standardize claim filing procedures, regardless of your location, for durable medical equipment, independent clinical lab, and specialty pharmacy claims, the BlueCross BlueShield Association requires all Blues plans to comply with the following billing mandates.
Issue 17 - Patient Reviews: Online Survey
This July, we will launch a Patient Reviews survey within the Provider Search function on our website. This will make it possible for members to provide feedback on their experiences with doctors, dentists, and other health care professionals.
Issue 16 - Introducing Our New Website!
On July 1, 2012, the new BlueShield of Northeastern New York website will make its’ debut.
Issue 15 - Paperless Initiative: Dental Claims
BlueShield of Northeastern New York’s paperless initiative now includes the submission of electronic dental claims.
Issue 14 - Dental Providers: Credentialing and Recredentialing through CAQH
Effective August 1, 2012, all dental providers are required to enter their credentialing information (free of charge) in the secure online data center at the Council for Affordable Quality Healthcare (CAQH) website.
Issue 13 - Billing and Reimbursement of Prostate Biopsy Services
Effective September 1, 2012, the global reimbursement for professional pathology services for prostate biopsy codes 88305 and 88307 will be capped at nine units.
Issue 12b - Reimbursement Change Sclerotherapy Service
Effective September 1, 2012, reimbursement fees for sclerotherapy services will change.
Issue 12a - Reimbursement Change Sclerotherapy Service
Effective September 1, 2012, reimbursement fees for sclerotherapy services will change.
Issue 11 - Drug Therapy Guideline Updates
Drug therapy guideline updates effective June 15, 2012.
Issue 10 - High Risk Medications
The Pharmacy Quality Alliance has determined that the medications on the enclosed list have the highest risk of side effects for elderly patients.
Issue 09 - Fee Update_Balloon Sinuplasty
Codes reimbursed according to a site-of-service differential will be updated on August 1, 2012.
Issue 08 - CMS Medicare Advantage Appeal Notice Update
Directors of utilization review and/or case management departments should be familiar with the updated information about Medicare Advantage Appeal Notices from the Centers for Medicare and Medicaid Services (CMS).
Issue 07 - Medical Protocols Updates
The enclosed changes are effective May 1, 2012.
Issue 06 - Reimbursement Changes Medical Injectables
Effective July 1, 2012, we will add a fourth tier to our reimbursement methodology for provider-administered medical injectable drugs.
Issue 05 - Drug Therapy Guideline Updates
Drug therapy guidelines for Orencia and Travatan-Z have been updated.
Issue 04 - Adjustment Policy Reminder
We want to remind you about our Standard Claim Adjustment Policy.
Issue 03 - Association for Medical Ethics
We are partnering with the Association for Medical Ethics (AME) to encourage the use of evidence-based medicine to improve patient care.
Issue 02 - Radiation Therapy Treatment Notification Form for Transition Cases Required for New Members
A Radiation Therapy Treatment Notification Form for Transition Cases is required for new members (enrolled on or after January 1, 2012) who are currently receiving radiation therapy treatment.
Issue 01 - Level-of-Care Review Update
Effective February 15, 2012, we will begin a two-step review process for elective inpatient hospital procedures.