Tagged with BCBS Blue Cross Blue Shield
Anthem’s behavioral health medical policies and clinical guidelines currently in place for reviewing of behavioral health services, will be replaced by the MCG Care Guidelines 22nd edition Behavioral Health guidelines.
Following review of the CPT and HCPCS, Blue Cross and Blue Shield of Vermont (BCBSVT) has posted several coding, prior approval, investigational services, and unit designation changes.
The Department of Labor (DOL), on June 18, issued a final rule that will expand consumer availability of association health plans (AHPs) as of September 1, 2018.
Anthem Blue Cross Blue Shield (Anthem BCBS) will soon implement changes to its clinical payment and coding policy for several services and procedures.
A resolution has been introduced in Delaware that seeks to allow the state to look-into potential Medicaid buy-in options.
Anthem Blue Cross Blue Shield (BCBS) will update its facility policy for inpatient stay claims reimbursed at a percent of charge with billed charges above $40k will require additional documentation in certain states, beginning with dates of service on and after July 13th.
Anthem Blue Cross Blue Shield (BCBS) published a notice stating that effective with dates of service on and after July 1st a separate company, AIM Specialty Health (AIM), will apply AIM’s Radiation Oncology Clinical Appropriateness Guidelines to precertification requests for certain services.
As of July 1, Anthem Blue Cross and Blue Shield of Wisconsin (BCBSWI) will require unspecified diagnosis codes to only be used when an established diagnosis code does not exist to describe the diagnosis. Reimbursement will be based on review of the unspecified diagnosis code on an individual claim basis.
Blue Cross and Blue Shield of Rhode Island (BCBSRI) has updated its claims processing system. These updates became effective April 1 and include Category II performance measurement tracking codes and Category III temporary codes for emerging technology.
Blue Cross and Blue Shield of Vermont (BCBSVT) has released the list of recently updated medical policies and the corresponding effective dates.
Anthem Blue Cross Blue Shield of New Hampshire (BCBSNH) has released updates to its current reimbursement policy for E&M services and related modifiers 25 and 57 professional reimbursement, facility claims requiring additional documentation policy, as well as its pharmaceutical waste facility reimbursement policy.
Blue Cross Blue Shield of Massachusetts (BCBSMA) has released coding and payment updates for certain procedures and services, including venipuncture reported with labs or E&M service, interim caries arresting medicament, and others.
Anthem Blue Cross Blue Shield of Indiana (BCBSIN) Medicaid has released updates to certain coding and medical policies, including the use of unspecified diagnosis codes and prior authorization prior authorization for elotuzumab.
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.
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.
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 (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.
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.
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.
Effective with dates of service of February 1, 2018, and beyond, Highmark Blue Shield will require prior authorization for eleven procedure codes.