Tagged with BCBS Blue Cross Blue Shield
Effective with dates of service of February 1, 2018, and beyond, Highmark Blue Shield will require prior authorization for eleven procedure codes.
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.
Starting in 2018, more claim payments and remittance advice issued to Anthem providers will be made on a weekly basis.
Effective December 8, Anthem EDI began implementation of a new edit related to independent laboratory claims which reduces the processing time and manual intervention for lab claims.
For dates of service on or after December 1, 2017, Anthem Blue Cross and Blue Shield (Anthem BCBS) will begin reimbursement for Psychiatric Care Collaborative Management Healthcare Common Procedure Coding System (HCPCS Level II) codes.
Delaware’s Department of Health and Social Services (DHSS) has announced the names of the companies selected to operate its Medicaid Managed Care Program (MCO) in 2018
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.
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.
A medical policy from Blue Cross Blue Shield of Michigan sets the insurer apart as the first commercial payer to issue a positive coverage policy for a new lumbar spinal stenosis treatment.
The Office of the Health Insurance Commissioner approved health insurance premium rates in Rhode Island for 2018 that include exchange plan rate increases ranging from 5% to 12.1% for 2018.
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%.
Anthem Blue Cross and Blue Shield released updated medical policies and clinical guidelines to be implemented on November 1, 2017 in certain states.
Blue Cross Blue Shield of Massachusetts (BCBSMA) has posted a new version of the Outpatient Surgical Day Care list intended to help providers determine the most appropriate setting for services receive.
Harvard Pilgrim, Maine Community Health Options, and Anthem Blue Cross Blue Shield are each requesting double-digit rate increases for 2018. The three insurers cite political uncertainty and a higher percentage of unhealthy policyholders as reasons for their requests.
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.
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.
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 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.
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.
The Delaware Department of Insurance is investigating a security breach involving subcontractors of Highmark BlueCross BlueShield of Delaware: Summit Reinsurance Services Inc. and BCS Financial Corp.