Tagged with BCBS Blue Cross Blue Shield
Anthem BCBC Provider Payment Schedule Update
Starting in 2018, more claim payments and remittance advice issued to Anthem providers will be made on a weekly basis.
Anthem EDI Edit for 837 Professional Independent Lab Claims
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.
Anthem Integrated Medical and Behavioral Healthcare Reimbursement Policy Update
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.
DE DHSS Announces Medicaid Managed Care Program Operators
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
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.
BCBSMI – 1st Private Payer to Cover Paradigm Spine’s Coflex
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.
RI – Exchange Plan Rate Increases Approved for 2018
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.
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%.
Anthem BCBS – Medical Policy and Clinical Guideline Updates
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) Releases 2017 Surgical Day Care List Updated
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.
ME – State Insurance Companies Want Double-Digit Rate Increases For 2018
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.
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.
DE – DOI Investigating Highmark BlueCross BlueShield Data Breach
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.
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.