News from BCBSVT

May 18, 2020

Temporary Emergency Policies Update

All temporary/emergency policies created for COVID-19 have been extended until December 31, 2020.  Below is a list of the policies:

  • CPP_24 Telephone-Only Services

  • CPP_25 Telephone Triage

  • CPP_26 Preventive Medicine by Telemedicine Policy

  • CPP_27 Physical Therapy, Occupation Therapy and Speech Therapy by Telemedicine

  • CPP_28 Intensive Outpatient Therapy Services and Psychotherapy (crisis and group) Service by Telemedicine or Telephone

  • CPP _29 Applied Behavior Analysis (ABA) by Telemedicine or Telephone

  • CPP_30 Waiver of Cost Share for COVID-19-Related Testing, Diagnosis, and Treatment

  • CPP_31 Waiver of Cost Share for COVID-19 Acute Outpatient Treatment and companion COVID 19 Acute Outpatient Treatment Medical Policy

  • Utilization Management Policy and Procedure

We are working to update each policy and re-post.  If you have any questions, please contact your provider relations team by email at providerrelations@bcbsvt.com or phone at 888 449-0443.

 

April 22, 2020

Medical Policy Updates for 7/1/2020

There are updates to existing medical policies that are effective as of 7/1/2020.

Click here for full details.


835s for Other Blue Plan Medicare Primary Members

April 21, 2020

We have implemented a new program that allows for other Blue Plans to provide 835’s containing claim processing for their members who have a Medicare supplemental policy or a Blue Cross and Blue Shield policy secondary to Medicare that have crossed over from the Medicare COBA program.

Click here for full details.


COVID-19 Related Testing, Diagnosis and Treatment

April 20, 2020

Member cost share is waived for:

  • Office visit (in person or via telemedicine) related to the screening/testing for COVID-19
  • Inpatient hospital treatment of COVID-19
  • Outpatient Services (including office visits, and ground ambulance transport) for the acute treatment of COVID-19

Click here to review the payment policy for screening/testing and inpatient hospital care.
Click here to review the payment policy for outpatient services (including office visit and ground ambulance).
Click here to review the Medical Policy for COVID-19 Acute Outpatient Treatment.

Remember, for the members cost share to be waived, the appropriate diagnosis (as defined by each payment policy- please see specific policy for full details) must be reported in the first diagnosis field:

  • Screening/Testing Diagnosis: Z03.818 or Z20.828
  • Inpatient and Outpatient Services Diagnosis: U07.1 (for services on or after 4/1/2020) or B97.29 (for services prior to 4/1/2020)

In Network Independent Laboratories Providing COVID-19 Testing

April 15, 2020

Click here for details on in network labs that can turn COVID-19 testing around in 24-48 hours and have unused capacity.


Provider/Facility Enrollment during the COVID-19 Crisis

April 13, 2020

We have temporarily revised our provider and facility enrollment process, requiring less paperwork or in some cases, no paperwork at all.

Click here for full details.


Our Mailroom is Closed

April 8, 2020

Click here for information on what to do with documents you typically mail, such as:

  • Administrative Changes Due to the Coronavirus
  • Appeals
  • Customer Services
  • Paper Claim Submissions
  • Payments to Providers
  • Prior Approval/Pre-Determination
  • Provider Enrollment and Demographic Changes

Telephone Services, Including Telephone Triage

April 7, 2020

Click here to see all related information.


Telemedicine

April 6, 2020

Click here to see all related information.


Attention: Hospitals, Skilled Nursing Facilities, Home Infusion Therapy, Home Health Agencies, Inpatient Mental Health and Substance Abuse Facilities and Acute Rehabilitation Facilities

April 1, 2020

We are relaxing certain utilization management and auditing-related requirements on an emergency/temporary basis in light of the COVID-19 pandemic.

Click here to view the policy that provides the full details of the changes.


New, Revised & Deleted Codes for April 1, 2020 (Adaptive Maintenance)

March 27, 2020

We are in the process of completing our review of the CPT®/HCPCS additions, deletions and revisions for April 1, 2020.

This could result in some changes to:

  • Prior approval
  • Investigational services
  • Unit designation
  • Non-Covered
  • Other Changes
  • Fee/Allowed Amounts

Click here for the full details.


HEDIS Medical Record Data Collection Cancelled

March 26, 2020

Due to the Coronavirus and the need to keep everyone safe, we have cancelled the 2020 HEDIS data collection (for 2019 charts). If you have received a request from Change Healthcare for BCBSVT member(s), please disregard. If an appointment has been scheduled with Change Healthcare staff for chart pulls, you can consider it cancelled.

If your practice uses CIOX for medical records retrieval, Change Healthcare is notifying them of the cancellation.

We will resume HEDIS data collection in 2021 for 2020 data.

If you have any questions, please contact the provider relations team through email at providerrelations@bcbsvt.com or phone at (888) 449-04443 option 1.


ClaimCheck

March 09, 2020

The ClaimCheck software will be upgraded on May 8, 2020. Click here for more details.


AIM Guideline Change

March 02, 2020

Effective May 17, 2020 the AIM Clinical Appropriateness Guidelines for Advanced Imaging: Vascular Imaging are changing. The new guidelines are posted on the AIM website.

If you have any questions, please contact the provider relations team by email at providerrelations@bcbsvt.com or phone at (888) 449-0443 option 1.


Updated Payment Policy

February 27, 2020

We have updated the Payment Policy for Use of Non-Participating Providers. Click here for details.


Unit Listing

February 17, 2020

We now have a complete listing of unit designations for all CPT/HCPCS codes. It is posted under the Provider Manual/Handbook& Reference Guides section of the website.


HEDIS is underway

February 17, 2020

It is that time of year again! Healthcare Effectiveness Data and Information Set (HEDIS®) medical record data collection for 2019 is starting in February.

If you are contacted by Change Healthcare for medical record collection, we request you follow the instructions provided and respond promptly.

If you have any questions, please contact the provider relation team through email at providerrelations@bcbsvt.com or by phone at (888) 449-0443 option 1.


You're Invited!

February 17, 2020

Please consider participating in the 2020 Learning Collaborative for Asthma and COPD. Sign up is required by Friday, February 28, 2020. Click here for full details.


Chiropractors:

January 13, 2020

Prior Approval requests through Acuity Connect have changed. Click here for full details.


Provider Resource Center (Secure Site) – Supported Browsers

January 13, 2020

To better align with industry security standards, the following older browsers will no longer be supported as of January, 19, 2020:

  • Internet Explorer 7 thru 10
  • Safari 1 thru 6
  • Fire Fox 1 thru 26
  • Opera 1 thru 16
  • Chrome 1 thru 29

All modern browsers that auto update such as Internet Explorer, Chrome, Firefox, Safari, and Edge will continue to work.


Dentists contracted with FEP

January 13, 2020

The Federal Employee Program Maximum Allowable Charge fee master has not changed for 2020, it remains the same as 2019.

If you have questions or would like a copy, please contact the provider relations team at providerrelations@bcbsvt.com or (888) 449-0443 option 1.


BCBSVT Identification Cards

January 10, 2020

ID cards are not reissued to BCBSVT members on an annual basis (or upon their insurance renewal). Last year was an exception as we revised our member numbers.

ID cards are reissued if there is change in the member's coverage that makes the card inaccurate or if the member needs a card replaced.

Members may present with ID cards with a print date of 2019, and those are still active and valid.

As always, in addition to checking the ID card you should validate eligibility by submitting a 270/271 transaction, an eligibility request through the provider resource center, or by contacting the appropriate BCBSVT customer service team.

If you have any question or need information on how to submit an eligibility request, please contact the provider relations team by email at providerrelations@bcbsvt.com or by phone at (888) 449-0443 option 1.


Risk Coding Project

January 09, 2020

BCBSVT has partnered with Reveleer for the medical record retrieval of 2019 claims identified in the risk coding project. If you receive a request from Reveleer, please be sure to respond promptly following the instructions they provide.

If you have any questions about this notice, contact the provider relations team at providerrelations@bcbsvt.com or phone at (888) 449-0443.

If you have question on Risk Coding or the project, please contact Stacy Moran, Risk Adjustment Coordinator at morans@bcbsvt.com or phone at (802) 371-3537.


PCP Selection Criteria

December 27, 2019

The Quality Improvement Policy for Primary Care Provider Selection Criteria has been updated and posted to the secure provider portal under BCBSVT Policies/Quality Improvement. If you require a paper copy, please contact the provider relations team at (888) 449-0443 option 1.


REMINDER

December 23, 2019

Verifying eligibility and confirming the requirements of a member's policy before you provide services is essential, especially as we start a new calendar year.

Most of our large employer groups have January renewals and as a result they change benefit structures and member liabilities.

For example, this year a few of the changes are for benefits related to:

  • Bariatric Surgery – some members will be required to receive services in a Blue Center of Distinction
  • Blepharoplasty – some members will now have coverage who previously did not
  • Pharmacy (Vermont Educational Health Initiative retirees – over and under 65)

There are two methods to verify eligibility of Blue Cross and Blue Shield of Vermont (BCBSVT) or Federal Employee Program (FEP) members:

  • Electronic: Submit an electronic transaction via the tool located on the provider website at www.bcbsvt.com. For specific details, please refer to our on line Provider Handbook at www.bcbsvt.com under Section 3.
  • Phone:
    • BCBSVT customer service at (800) 924-3494
    • FEP customer service at (800) 328-0365.

Prefix Listing updated for 2020

December 20, 2019

The prefix listing posted to the reference guide link has been updated for January 1, 2020. The only change is for New England Health Plan, Access Blue New England and BlueChoice New England Prefixes, there are ten new prefixes this year. If you require a paper copy, please contact the provider relations team at (888) 449-0443 option 1.


FEP Prior Approval List

December 19, 2019

The 2020 FEP prior approval lists for FEP Blue Focus and FEP Standard & Basic Options has been posted to the prior approval link. If you need a paper copy, please contact the provider relations team at (888) 449-0443 option1.


Clinical Practice Guidelines

December 19, 2019

The Quality Improvement Policy for Clinical Practice Guidelines has been updated. It is available on the secure site under BCBSVT Policies/Quality Improvement. If you require a paper copy, please contact the provider relations team at (888) 449-0443 option 1.


Billing for Dry Needling as of January 1, 2020

December 16, 2019

There are new codes to use. Click here for full details.


New, Revised & Deleted Codes for January 1, 2020 (Adaptive Maintenance)

December 16, 2019

BCBSVT is in the process of completing our review of the HCPCS/CPT® codes additions, deletions and revisions for January 1, 2020. This could result in some changes to:

  • Prior approval
  • Investigational services
  • Unit designation
  • Non-Covered
  • Modifiers
  • Other Changes
  • Telemedicine
  • Fee/Allowed Amounts

Click here for full details and a reminder on other changes for January 1, 2020.


2020 Holiday Schedule

December 05, 2019

The 2020 BCBSVT Holiday Schedule is available. Click here to review.


DME Medical Policy Delayed

November 25, 2019

DMEPOS Medical Policy:

The Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) medical policy has been delayed and will not be effective on January 1, 2020. We will provide a future notification with a new effective date.


Laboratory Reminders

November 14, 2019

Only order lab services that are medically necessary for the patient's care. Please do not order lab panels or a series of labs unless every lab in the panel is required for the care of the patient.

If an ordered lab service requires prior approval, make sure the prior approval is obtained.

Our network of independent laboratories and specimen draw stations changed. Click here for current Independent Laboratory Network, or here for the Vermont Draw Sites Brochure.

Note: Affiliated Labs/Northern Lights in Rutland is not a contracted independent laboratory or specimen draw station. If you have a patient with a standing orders at this entity, please outreach to the member and redirect their standing orders to an in-network laboratory or specimen draw station.


FAQ for Use of Non-Participating Providers Payment Policy

November 12, 2019

In response to questions form our provider community about our "Use of Non-Participating Providers Payment Policy" we have created a list of frequently asked questions. The FAQ's are available on the secure provider portal under BCBSVT Policies/Payment Policies. If you require a paper copy, contact Provider Relations at (888) 449-0443.


Change in format for Customer Service Responses

November 12, 2019

Effective immediately, customer service will use a check list to return review/appeal inquiries that do not qualify. Attached to the checklist will be the original submitted documentation. Click here to view a sample of the check list.

If you have any questions about this change, please contact the provider relations team at (888) 449-0443.


Integrated Health (IH) Fax Number

November 12, 2019

The fax number for our IH team is (866) 922-8778. If you are still using the old 802 number, please immediately update the fax number in your system(s).


Medical Policy Updates for 1/1/2020

October 30, 2019

There are updated and new medical policies that are effective as of 1/1/20, click here for full details.


Payment Policies

October 30, 2019

Payment Policies are posted to the secure provider portal (also referred to as the Provider Resource Center) under the link for BCBSVT Policies/Payment Policies.  Paper copies are available by contacting the provider relations team at (888) 449-0443.

Three new payment policies have been created and are effective on the dates indicated below:  

  • Modifier 52 (effective January 1, 2020)
  • 30 Day Readmission (effective February 1, 2020)
  • Never Events and Hospital Acquired Conditions (effective January 1, 2020) – this has moved from a Quality Improvement Policy to a Payment Policy and includes some changes.  The Quality Improvement Policy will be terminated as of 12/31/19.

We have updated our payment policy for the Global Maternity/Obstetric Package and the changes are effective on January 1, 2020.


New Coding Advisor Program

October 30, 2019

We have contracted with Change Healthcare Solutions, LLC, for its Coding Advisor Program.

Beginning in February of 2020, Change Healthcare will review the use of high-level service codes (e.g., 99205, 99215, etc.) for all providers and identify cases where providers are billing high-level codes with significantly greater frequency than other providers with the same specialty.

Change Healthcare is a business associate of BCBSVT, so if you receive a call or request for documentation from Change Healthcare, please provide a prompt response.


Coverage of 96160

October 21, 2019

Effective October 1, 2019 BCBSVT provides coverage, without member liabilities for CRAFFT Assessments (if the patient is 11 years of age or older) and Acute Concussion Evaluation billed with CPT® Code 96160.

Click here for full details, including billing instructions.


Acuity Connect Scheduled Maintenance:

October 10, 2019

Acuity Connect, our on line prior approval submission tool for medical services, will be unavailable from 6:30 pm, Friday, October 11the through 6:30 pm, Sunday, October 13th.

If you need to request a prior approval during this time period, you can do so via fax at (866) 387-7914. The fax must include a completed State of Vermont Uniform Medical Prior Authorization form and any supporting documentation.

If you are not familiar with the fax submission process for prior approvals, details are available at bcbsvt.com/provider under the link Prior Approval/Pre-Notification/Pre-Services Requests –Requirements and Forms link.

We apologize for any inconvenience this may cause.

Please note: Express Scripts, Inc (our pharmacy benefit manager) and AIM Specialty Health (our radiology benefit manger) on-line prior approval tools will be available during this time. They are not impacted by this maintenance.


Prior Approval List

October 2, 2019

We have combined our two prior approval lists (Services and Procedures requiring prior approval and the Durable Medical Equipment, Orthotics and Prosthetics requiring prior approval) into one document and posted to the Prior Approval area of the provider website. In addition, we have updated the prior approval list to include the October 1, 2019 changes.


Unit Designation

October 1, 2019

The Unit Designation listing has been updated to include October 1, 2019 changes and posted to the Provider Manual/Handbook & Reference Guide Section under General, or you can request a paper copy by contact provider relations at providerrelations@bcbsvt.com or by phone at (888) 449-0443 option 1.