Volume 13, 2007

Issue 33 - What Healthcare Providers Need to Know about Medicare Private Fee-For-Service
BlueCross BlueShield of Western New York is pleased to announce that as of January 1, 2008, we will offer Traditional Blue Medicare Private-Fee-For-Service (PFFS) to Medicare eligible consumers. This plan allows members to see the Medicare provider of their choice without a network restriction.
Issue 32 - Part D Covered Vaccines and Administration
n 2008, CMS requires that vaccines and the administration fees associated with vaccines be covered under Part D, instead of Part B.
Issue 31 - Inhalation Medication Benefit Change for Medicare Advantage
The following bulletin contains important information regarding a benefit change for Medicare Advantage members.
Issue 30 - Documentation Required for Laser Procedures
Effective January 15, 2008, laser procedures for all Traditional contracts with a "Cosmetic Rider" will require clinical review.
Issue 29 - 2008 Fee Schedule Update
The following bulletin contains information regarding BlueCross BlueShield's upcoming fee schedule changes, site-of-service payment differentials and an explanation of our reimbursement methodology.
Issue 28 - NPI Updates
BlueCross BlueShield is pleased to announce that beginning December 3, 2007, claims submitted with both an NPI and Legacy ID will be processed under the NPI.
Issue 27 - Duplicate Withdrawals Claims Adjustments
During an upgrade, BlueCross BlueShield experienced technical difficulties that resulted in duplicate withdrawals to some providers.
Issue 24 - 2007 - 2008 Flu Season Updates
This STAT Bulletin summarizes BlueCross BlueShield of Western New York’s 2007-2008 Flu Vaccine reimbursements and policies.
Issue 22 - Reimbursement for Injectable Medications and Administration Codes
BlueCross BlueShield of Western New York will be changing the fee schedule for Injectable Medications and Administration Codes effective October 15, 2007.
Issue 21 - NPI Contingency Plan
BlueCross BlueShield has changed the date for accepting NPI only for electronic and paper claims. HealthNow will be able to accept NPI only as of December 3, 2007.
Issue 20 - Reimbursement for Injectable Medications
The affected drugs and associated fees will be posted by September 15, 2007 on our web site at www.bcbswny.com prior to being implemented.
Issue 19 - Preauthorization Requirement Removed
The following bulletin contains important information regarding admissions to Erie County Medical Center.
Issue 18 - New Fee Schedule for Orthotic and Prosthetic Codes
Based on numerous inquiries received from our provider community, BlueCross BlueShield will be implementing a change in our reimbursement for HCPCS "L" codes.
Issue 17 - Reminder: Medicaid Managed Care and Family Health Plus Members Cannot Be Billed
When a provider accepts a Medicaid Managed Care or Family Health Plus member as a patient, the provider agrees to bill the managed care plan for services covered by the contract.
Issue 16 - Referral Guidelines for In-Network Benefits
The following bulletin contains reminders regarding referrals for in-network benefits for members, PCPs, and Specialists.
Issue 15 - Reimbursement for Injectable Medications
We have since determined that implementation of this process will be delayed until October 1, 2007.
Issue 14 - PaySpanHealth Going Live July 17, 2007
Last fall, BCBSWNY communicated that we would offer providers the opportunity to enroll with PaySpan Health. We are pleased to announce that PaySpan Health will be operational beginning July 17, 2007.
Issue 13 - Reimbursement for Injectable Medications
Effective August 1, 2007, with the exception of some immunizations, BCBSWNY has decided not to follow Medicare's ASP methodology for reimbursement of injectibles.
Issue 12 - Preauthorization Reminder for Skilled Nursing Facilities and Acute Rehabilitation Admissions
The following contains steps and information when a BlueCross BlueShield member has been referred to your facility for a SNF/Rehab admission.
Issue 11 - Medicaid Managed Care, Child Health Plus, Family Health Plus July 15, 2007 Fee Schedule Changes
BCBSWNY recently completed analysis of our Medicaid Managed Care, CHO and FHP fee schedule. As a result, effective July 15, 2007, our reimbursement of Evaluation and Management codes will be updated.
Issue 10 - Board Certification Requirement
Effective July 1, 2007 BCBSWNY requires all new physician practitioners other than those who have completed their training within the previous five (5) years to be board certified in their specialty.
Issue 9 - Please Submit G codes for All Lines of Business
In an effort to collect data for future quality measures, BlueCross BlueShield of Western New York is requesting physicians to submit the G codes to our plan for all lines of business.
Issue 8 - Prefix Changes for Child Health Plus, Family Health Plus, Medicaid MCO and Medigap
The former prefix for Child Health Plus, Family Health Plus and Medicaid MCO 501 was YJC. In order to identify members with these products more clearly, the products have been assigned new prefixes.
These program benefits are for routine vision care services only. Medical services fall under the member's medical/surgical benefits and require a referral from the PCP.
Timothy’s Law is effective for all employer groups — new and existing — that renew on or after January 1, 2007. The provisions of the law are applicable as each group renews its benefits during 2007.
Issue 5 - Continuous Passive Motion in the Home Setting
This bulletin contains important information regarding coverage of the Continuous Passive Motion exercise device.
Issue 4 - Important News Regarding Administration Codes 90471 and 90472
The changes to our system for reimbursement of vaccination delivery codes 90471 and 90472 are in production as of Friday, February 9, 2007.
Issue 3 - Clarification of Changes to Family Health Plus, Child Health Plus and Medicaid Managed Care Products
BlueCross BlueShield will not be closing our Family Health Plus, Child Health Plus and Medicaid Managed Care products to new membership.
Issue 2 - Claims Overpayment Recovery Process Changes and Significant System Edits Publication Notice
This bulletin summarizes BlueCross BlueShield of Western New York's compliance activities related to Chapter 551 of the 2006 Laws of New York State ("Bradley Bill").
Issue 1 - Computerized Corneal Topography Coding Change
The following bulletin contains important information regarding billing guidelines for Corneal Topography.