Volume 13, 2015

Issue 35 – Updated Fax Number for Medicare Advantage Part D Preauthorization Requests
We want to let you know that the fax number for Express Scripts preauthorization requests has changed.
Issue 34 – Dental Benefits Administration to Change
We want to let you know that, beginning Jan. 1, 2016, we will begin administering dental benefits for our individual and small group plans.
Issue 33 – Medicare Advantage Medical Savings Account (MSA) Plan Discontinued
We want to let you know that we will not be offering Medicare Advantage MSA plans in 2016.
Issue 32 – Lab Vendor to Change
We want to let you know about a change to outpatient laboratory services for your BlueShield of Northeastern New York patients.
Issue 31 – 2015 Pay for Performance Program Update
We want to remind you that you can submit medical records for P4P quality compliance measures until Jan. 31, 2016.
Issue 30 – Drug Therapy Guideline Updates
We want to let you know about our updated drug therapy guidelines that will take effect December 15, 2015.
Issue 29 – Drug Coverage Changes
We want to let you know about drug coverage changes that will take effect January 1, 2016.
Issue 28 – Preauthorization through Express Scripts for our Medicare Advantage Part D Plans
Effective January 1, 2016, preauthorizations for medications for our Senior Blue HMO and Forever Blue PPO Part D members will be handled by Express Scripts®.
Issue 27 – Change to our Performance and Quality Programs Measure
We want to let you know about a change to our 2015 physician performance and quality initiatives.
Issue 26 – Important Notification Regarding Your Credentialing Application
We want to remind you that we need your most up-to-date credentialing and practice status information in order to complete your credentialing review.
Issue 25 – Elective C-Section and Induction of Labor
The New York State Department of Health requires hospitals to include a condition code identifying gestational ages of newborns on all obstetric delivery claims for Medicaid fee-for-service and Medicaid managed care enrollees.
Issue 24 – Important Notification Regarding Fee Schedule Changes and Performance and Quality Programs
We want to let you know that effective January 15, 2016, the fee schedule for the annual wellness visit (AWV) will change.
Issue 23 – Anesthesia Billing Reminder
Effective October 1, 2015, anesthesia services should be billed using the Current Procedural Terminology (CPT®) code range 00100 – 01999.
Issue 22 – Health Insurance Exchange
With open enrollment approaching, we want to share with you some quick facts about New York state’s health insurance exchange.
Issue 21 – Drug Therapy Guideline Updates Available Online
We want to let you know about drug therapy guidelines that will take effect September 15, 2015.
Issue 20 – Changes to Coverage for In-Office HbA1c Testing
We want to let you know about important changes in coverage for in-office HbA1c testing for patients with diabetes, effective August 1, 2015.
Issue 19 – 2015 P4P Update (Medical Records)
We want to let you know that you can submit medical records for P4P quality compliance measures beginning July 1, 2015 through January 31, 2016.
Issue 18 – Anesthesia Billing Update
We want to let you know about upcoming changes to billing and reimbursement for anesthesia services.
Issue 17 – 2014 Pay for Performance Program
Performance summaries for your recent 2014 Pay for Performance (P4P) incentive payment are now available.
Issue 16 – Physical Medicine_Codes_ Update
We want to let you know about upcoming changes to the reimbursement for physical medicine and rehabilitation tests and measurements codes.
Issue 15 – Important Notification_AWV In-Home
We want to remind you that you can earn additional incentives by taking advantage of our annual wellness visit (AWV) initiative using the Vatica Health tool.
Issue 14 – Revised ICD-10 Rules for UB-04 Claims
Effective July 16, 2015, the transition from ICD-9 to ICD-10 procedure and diagnosis codes effects the diagnosis fields that are currently used on the UB-04 claim forms.
Issue 13 – Pharmacy Coverage Changes Available on our Website
We want to let you know that the attached pharmacy coverage changes will take effect July 1, 2015.
Issue 12 – Chiropractic Maintenance Benefits
We want to remind you that some health plan contracts provide chiropractic maintenance benefits.
Issue 11 – Drug Therapy Guideline Updates
We want to let you know that the attached drug therapy guidelines will take effect June 15, 2015.
Issue 10 – Performance and Quality Program Update
We want to let you know about the 2015 quality initiative to support your efforts in conducting annual wellness visits for your Medicare Advantage (MA) patients.
Issue 9 – Important Notification Regarding Changes to our Fee Schedule and our Performance and Quality Programs
We want to let you know about additional changes to our 2015 physician performance and quality initiatives.
Issue 8 – Medical Protocol Update: Monitored Anesthesia Care
We want to let you know about a recently archived medical protocol: Monitored Anesthesia Care (MAC).
Issue 7 – Medical Protocol: Gender Reassignment Surgery
We want to let you know about a new medical protocol: Gender Reassignment Surgery.
Issue 6 – Updates to Vouchers
Effective Sunday, April 19, 2015, we’re making changes to many of our explanation codes to more accurately reflect provider and member liability amounts on BlueCard® host claims.
Issue 5 – Changes to our Performance and Quality Programs
We want to let you know about our 2015 physician performance and quality initiatives.
Issue 4 – Updated Claim Form Reminder
We want to remind you that effective March 15, 2015, incomplete claims will be returned. As you may recall, we notified you last April that the transition from the previous version of the CMS-1500 claim form (8/05) to the revised version (2/12) was implemented on April 1, 2014.
Issue 3 – Consumer Driven Health Plans
We want to remind you that consumer-driven health plans are a popular option for employers who want to offer their employees coverage with lower premiums.
Issue 2 Drug Therapy Guideline Updates
We want to let you know that the attached updated guidelines will be effective March 1, 2015 and March 15, 2015, respectively.
Issue 1 - Retrospective Review for Chiropractic Care
We want to let you know that starting March 10, 2015, our chiropractic program will now include retrospective audits for medical necessity after the 14th office visit.