Volume 15, 2017

 

Issue 39 – Medicare Outpatient Observation Notice (MOON) Requirement
We'd like to remind you to provide the Medicare Outpatient Observation Notice (MOON) form to BlueCross BlueShield of Northeastern New York Medicare Advantage members, as required by the Centers for Medicare and Medicaid Services (CMS).
Issue 38 – Fractional Flow Reserve - Computed Tomography
As part of the BlueShield or Northeastern New York Radiology Management Program FFR-CT will require preauthorization through National Imaging Associates (NIA), a Magellan Company.
Issue 37 – 2018 Pay for Performance Program
We want to let you know about our 2018 Pay for Performance (P4P) Program.
Issue 36 – Notification of CMS Coding Change - Bill Type 0322
You should be aware of changes made by the Centers for Medicare and Medicaid Services (CMS) guidelines to bill type 0322.
Issue 35 – Important Changes to the Use of Consultation Services CPT Codes
To better align with standards set by the Centers for Medicare & Medicaid Services (CMS), BlueShield of Northeastern New York will no longer recognize consultation CPT codes, effective March 15, 2018.
Issue 34 – Demographic Change Requests Through Email
You now have an easier way of submitting demographic change requests, through email.
Issue 33 – Correct Use of CPT Code Modifiers
As of January 1, 2018, BlueShield of Northeastern New York will implement a process that is aligned with CPT/HCPCS coding guidelines for services that have often been coded incorrectly.
Issue 32 – Health Care Services: Chiropractic
We want to let you know about all the health care services programs available to your patients.
Issue 31 – Quest Lab Update
We want to remind you that Quest Diagnostics™ is our preferred laboratory for your BlueShield of Northeastern New York patients.
Issue 30 – Reimbursement Changes for Medical Injectables
Effective December 22, 2017, we will be updating our corporate medical injectable fee schedule. The changes will impact all participating physicians, skilled nursing facilities, and home-infusion pharmacies.
Issue 29 – Drug Therapy Guideline Updates
We want to let you know that we have updated the enclosed drug therapy guidelines.
Issue 28 – Receive Important Updates Electronically
We want to let you know that you can now receive important information from us via email.
Issue 27 – Chiropractic Medicare Advantage(AT) Modifier Requirement
As a reminder, the Active Treatment (AT) modifier is required for all Medicare Advantage members.
Issue 26 – Ultrasound Accelerated Fracture Healing Device
The Ultrasound Accelerated Fracture Healing Device Protocol policy position has been updated. The change takes effect January 1, 2018.
Issue – 25 Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 24 – BCBSA Prefix Notification to Providers
We want to let you know that, beginning April 15, 2018, member ID card prefixes for all BlueCross BlueShield plans will be expanded to include alpha-numeric prefixes. It’s important that you review your systems to make sure you can accommodate alpha-numeric prefixes.
Issue 23 – Wearable Cardioverter Defibrillator (Lifevest)
We want to let you know about a change in our medical protocols, which may affect coverage for the LifeVest® wearable cardioverter defibrillator for all lines of business effective August 1, 2017.
Issue 22 – Pay for Performance Program
We want to let you know about a new performance and quality incentive opportunity.
Issue 21 – Transition from Walgreens to CVS Provider Notification
We want you to know that starting November 1, 2017, CVS Specialty® is replacing Walgreens Specialty Pharmacy as our specialty pharmacy administrator.
Issue 20 – UB-04 Claim Form Changes and Reminders
We want to let you know that, effective October 1, 2017, incomplete claim forms will be returned.
Issue 19 – Fee Schedule Update
We have made updates to our commercial and physician incentive fee schedules.
Issue 18 – ESI Med D PA Fax Number Change
We want to let you know that the fax number for Medicare Part D preauthorization requests will change.
Issue – 17 Gold Carding Reminder
We want to remind you that, effective September 1, 2017, we are temporarily discontinuing our radiology “gold-carding” program for all lines of business.
Issue 16 – Drug Therapy Guidelines
We want to let you know that the attached drug therapy guidelines have been reviewed and updated by our Pharmacy and Therapeutics Committee.
Issue 15 – Behavioral Health Transition
We want to let you know that, effective August 28, 2017, we will be performing all Behavioral Health Utilization Management services.
Issue 14 – Lactation Counseling
We would like to inform you of a recent addition to our 2017 Commercial Fee Schedule.
Issue 13 – 2017 Vision Source Provider Fax
We want to let you know that a third party will soon be contacting our Medicare Advantage members to schedule diabetic retinal eye exams.
Issue 12 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 11 – Oxygen Services Reimbursement Adjustment
We are adjusting our monthly reimbursement rate for all oxygen services.
Issue 10 - Pay for Performance Program Announcements
We would like to thank you for participating in our 2016 Pay for Performance (P4P) Program, and our Medicare Advantage Colorectal Cancer Screening Quality Incentive.
Issue 9 – Benefit Information Available on HEALTHeNET
We want to let you know that benefit information for massage and acupuncture services is now available on HEALTHeNET (wnyhealthenet.com).
Issue 8 – Physical and Occupational Therapy Reimbursement Reminder
We want to remind you that reimbursement for physical and occupational therapy services continues to be paid by service encounter, not individual modality or treatment.
Issue 7 – Important Notification Regarding Additions to Our Quality Incentive Program
We want to let you know about additions to our Pay for Performance CPT II quality incentive program for 2017.
Issue 6 – Care at Home Indicator on ID Cards
We want to let you know that some of your BlueShield of Northeastern New York Medicare Advantage patients are eligible to participate in the Care at HomeSM program.
Issue 5 – Drug Therapy Guideline Updates Available Online
We want you to know that the latest drug therapy guideline updates are now available.
Issue 4 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 3 – Billing Guidelines for Dental Cone Beam Computed Tomography (CT)
We would like to provide clarification regarding the proper billing of dental cone beam computed tomography (CT).
Issue 2 – Important Fee Schedule Update
We want to let you know that effective July 1, 2017, the BlueShield of Northeastern New York Durable Medical Equipment (DME) fee schedule and rates are being updated to align with the Centers for Medicare & Medicaid Services (CMS) standards.
Issue 1 – Drug Therapy Guideline Updates Available Online
We want you to know that the latest drug therapy guideline updates are now available.
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