Tagged with BCBS Blue Cross Blue Shield

IL BCBSIL NDC Billing Update for Medicare Advantage Claims

Effective December 15, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement edits to validate National Drug Code (NDC)s that are submitted on electronic and paper, professional and institutional Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.

FL – 44.7% Proposed PPACA Rate Increase for 2018

Florida state officials have announced submission of the proposed rates for 2018 ACA plans. According to the announcement, premiums may increase by 44.7% next year for ACA compliant plans.

NY – 2018 Rate Increases Released

The New York Department of Financial Services has released 2018 health insurance rates for the state’s individual and small group markets, including rates for the NY State of Health, New York’s official health plan marketplace – ranging from 4.4% for Excellus to 31.5%.

OH – Anthem BCBS to Exit Ohio ACA in 2018

Anthem Blue Cross Blue Shield has announced it will leave the Affordable Care Act market in Ohio in 2018 and will reduce its footprint in the state to one off-exchange product in one county.

IL – Blue Cross Blue Shield Awaits State Review

For the first time since 1990, the Illinois Department of Insurance will conduct a broad market examination of Blue Cross and Blue Shield of Illinois to see how the insurer treats its customers in compliance with consumer protection regulations.

NJ – Governor Seeking Increased Control over Horizon BCBS

New Jersey is perusing increased oversight of the state’s largest health insurer, Horizon Blue Cross Blue Shield, after the Horizon Foundation for New Jersey declined to add $300 million to the state addition-treatment fund.

Aetna to Exit all ACA Insurance Marketplaces in 2018

Aetna has announced plans completely withdraw from the ACA insurance exchanges for 2018, citing financial losses as the deciding factor, specifically its individual commercial products lost nearly $700 million between 2014 and 2016 and could lose another $200 million this year.

Aetna: Payment Reduction for X-Rays Using Film

Applicable to the technical component, claims billed with modifier FX to indicate X-ray imaging services were provided using film reduces will be subject to a 20% reduction.

Study Finds New Payment Models May Potentially Reduce Health Care Disparities

A new study from Harvard Medical School claiming to have found “meaningful” improvements in quality, outcomes, and spending for all patients in the Alternative Quality Contract (AQC) between suggests binding insurers’ physician payments to quality metrics can narrow disparities between low- and higher-income patients.

WI – Report Shows 95% Covered As 2017 Enrollment Surges

A recent analysis by the University of Wisconsin Applied Population Laboratory showed that 94.3% of the state’s population had health insurance in 2015. Ranking seventh in percentage of residents covered across all states. According to HHS Regional Director Kathleen Falk, within the first month of 2017 open enrollment approximately 66,000 people in Wisconsin signed up for plans.