BCBS Blue Cross Blue Shield

Anthem CT Posts Advanced Imaging Clinical Appropriateness Guideline Updates

Anthem Blue Cross and Blue Shield (Anthem) of Connecticut (CT) released certain updates to its Vascular Imaging Clinical Appropriateness Guidelines which includes new and updated language for indication of asymptomatic enlargement by imaging and clarifying surveillance intervals for stable aneurysms.

Anthem Ohio Clinical Laboratory Improvements Amendments

Beginning May 1, claims that are submitted to Anthem Blue Cross and Blue Shield (Anthem) of Ohio for laboratory services subject to the Clinical Laboratory Improvement Amendments (CLIA) 1988 federal statute and regulations will require additional information to be considered for payment.

Anthem CT Outpatient Facility Edit Implementation

Beginning with claims processed on and after April 26, 2020, Anthem Connecticut will be enhancing its outpatient facility edits for revenue codes, Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System (HCPCS) and modifiers.

Anthem Connecticut Introduces New Prior Auth Pass Program

Anthem is introducing a new program to reduce the administrative burden associated with current prior authorization (PA) processes for providers who are contracted with Anthem in Connecticut. The Prior Auth Pass Program allows providers who meet program requirements to waive prior authorization for select outpatient medical procedures that generally have high rates of PA requests and approvals.

Anthem Medical Non-Oncology Specialty Drug Review Changes

Anthem Blue Cross Blue Shield (Anthem) continues to streamline its medical specialty drug reviews by transitioning another drug review process from AIM to Anthem’s medical specialty drug review team. Beginning June 15, for all requests, regardless of service date, providers will need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team.

Anthem Announces Fee Schedule Changes

Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.

Anthem BCBS Professional Bundled Services and Supplies Update

Anthem has released an update regarding the coding of bundled services for continuous intraoperative neurophysiology monitoring, from outside the operating room.

Wisconsin – Anthem Medical Policies and Clinical UM Guidelines Update

Anthem Wisconsin has updated certain medical policies and clinical utilization management (UM) guidelines to support clinical coding edits.

Anthem – Enhanced Automated Claim Edits

Anthem is updating its editing systems to automate edits supported by correct coding guidelines, as documented in industry sources such as CPT®, HCPCS Level II, and ICD-10. Anthem states the enhanced editing automation will promote faster claim processing and reduce follow-up audits and/or record requests for claims not consistent with correct coding guidelines.

Anthem BCBS Professional Reimbursement Updates

Anthem Blue Cross Blue Shield (BCBS) posted professional reimbursement updates for its policy for once per lifetime procedures bundled and services and supplies.

Anthem BCBS Connecticut Reimbursement Policies Updates

Anthem BCBS Connecticut has updated several of its reimbursement policies, including OBGYN policies, and language changes to professional reimbursement policies.

BCBS Vermont New, Revised and Deleted Codes Released

Following Blue Cross and Blue Shield of Vermont’s (BCBSVT) review of the CPT® and HCPCS additions, deletions and revisions for October 1, the insurer has made several changes involving prior approval, investigational services, and unit designation.

Anthem BCBS Medical Policy and Clinical Guideline Updates

Following a review of its current medical polices, Anthem BlueCross BlueShield (BCBS) has released an updated list of medical policies which will be converted to clinical guidelines, effective May 1.

Anthem Blue Cross and Blue Shield Virginia Coverage and Clinical Guideline Update

Effective May 1, Anthem Blue Cross and Blue Shield in Virginia (BCBS VA) will implement new and revised coverage guidelines approved at the most recent quarterly Medical Policy and Technology Assessment Committee meeting.

Texas CHIP Rural and Hidalgo Service Areas Contracts Announced

The Texas Health and Human Services Commission (HHSC) has announced the six contract awards for the state’s Children’s Health Insurance Program (CHIP) Rural and Hidalgo Service Areas scheduled to begin on September 1.

Anthem Blue Cross and Blue Shield Withdrawal of Modifier 25 Policy

Anthem Blue Cross and Blue Shield (BCBS) has published a notice informing health care professionals and policyholders that the insurer will no longer proceed with the reimbursement policy impacting physician use of payment Modifier 25.

Delaware Shifts Managed Medicaid Contracts to Value-Based Agreements

In an effort to improve outcomes, increase quality, and lower healthcare costs within Medicaid populations, Delaware says it will move its managed Medicaid contracts to value-based agreements.

Ohio – New Legislation Impacts Electronic Prior-Authorization Requests

As of January 1st, Ohio Senate Bill 129 (House Bill 505) now requires insurers to implement faster turn-around times for reviews of prior-authorizations (PA) that are submitted electronically.

Delaware Highmark to Require Prior Auth. for Eleven New Codes

Effective with dates of service of February 1, 2018, and beyond, Highmark Blue Shield will require prior authorization for eleven procedure codes.

New Hampshire Anthem BSBS New Musculoskeletal Program

Effective March 1, 2018, AIM Specialty Health (AIM) will perform medical necessity review of certain elective surgeries of the spine and joints, as well as interventional pain treatment for fully insured Anthem BSBS NH members.