News from BCBSVT

Telemedicine

April 6, 2020

Click here to see all related information.


EFT Issues

April 2, 2020

Electronic Fund Transfers will not occur on Friday. Due to a system issue, all March 31, 2020 payments were issued by check. The checks were mailed out yesterday via US Postal Service by our vendor (located in Indianapolis) and you should receive them early next week. We apologize for this inconvenience.

We are looking into the issue and anticipate resuming Electronic Fund Transfers next week.

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


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.


Enrollment of Temporary Providers During the Coronavirus

March 30, 2020

If you are adding temporary providers for the care of patients as part of a federal, state or local government emergency response team and intend to bill for these services, they will need to be enrolled with us. During this time, we have a temporary waiver of credentialing for these providers, so only enrollment is required. Complete the Provider Enrollment and Change Form (PECF) either electronic or on paper putting “COVID-19/EMERGENCY PROVIDER” on the comment line.

If you are submitting a paper PECF, do not mail. Use one of the methods below:

Retroactive enrollment up to 30 days will be allowed for temporary providers.

We continue to monitor the situation and if there is a change in enrollment guidelines for these temporary providers, a notice will be posted here.

Questions related to enrollment can be direct to Provider Files at (888) 449-0443 option 2.


Provider Enrollment and Demographic Changes

March 30, 2020

Do not mail in Provider Enrollment and Change Forms or Group Enrollment Change Forms. Send these to us using one of the methods below:

  • Fax to “Attention Provider Files” at (802) 371-3489 or
  • Email to Provider Files

Questions can be directed to Providerfiles@bcbsvt.com or by phone at (888) 449-0443 option 2.


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.


Our Payments to our Providers

March 26, 2020

We do not anticipate any interruption in payments to providers: Most providers receive payments through Electronic Fund Transfers (EFT) and there are no anticipated delays. For those not receiving EFT, paper checks are being issued by our vendor without any delays and mailed through the US Postal Service. Delivery of checks depends on the US Postal Service and whatever measure(s) they may implement due to the Coronavirus.

If you receive a paper check, please consider signing up for EFT. Go to this link and follow the instructions.

Once you have completed enrollment, remember to sign up for the Provider Resource Center so you can review/download copies of your provider vouchers, as they will no longer be mailed once EFT starts.


Customer Service Changes

March 26, 2020

Paper Inquiries or documents you normally mail to the attention of Customer Service must be emailed or faxed to the appropriate Customer Team.

Service TeamEmail AddressFax Number

Our Customer Service team
Provide service for:  BCBSVT members, and claim processing concerns for BlueCard, New England Health Plan and Access Blue New England members customerservice@bcbsvt.com(802) 225-7698

Federal Employee Program

fepcustomerservice@bcbsvt.com

(802) 225-7700

Responses are provided within 1 – 3 business days.

For an indefinite period, the customer service teams will accept corrected claim information over the phone. Please make sure you have the original claim information available (including claim number if available) and details on the changes you require prior to your call.


Prior Approval/Pre-Determination Reminder and Changes

March 26, 2020

Providers requesting prior approval must use one of the methods below:

  • Use the Acuity Connect Tool located on the Provider Resource Center (PRC) or
  • Fax to “Attention: Integrated Health Team” at (866) 387-7914, make sure to include the State of Vermont Uniform Prior Approval form and attach any related medical documentation.

It is extremely important that you provide the fax number of both the requesting provider and servicing provider with either method of submission. In the case of a denial, you will receive a response via fax.

BCBSVT Decision Notices for Prior Approval Change:

If a prior approval is approved, you will be advised to go to the PRC or Acuity Connect to review the details and if you need, obtain a copy of the letter.

If a prior approval is denied or requires more information, you will receive a phone call and follow up fax with the details.


Paper Claim Submission Change

March 26, 2020

Do not mail paper claims to us.

Instead, use one of the options below:

  • Fax to “Attention Claims Department” at (866) 334-4232 or
  • Email (make sure you send through a secure method) to claims@bcbsvt.com

Note: This should not happen, but if your fax fails and you have an older fax machine, when re-sending, make sure you send the entire fax again from the beginning. Older fax machines tend to pick up the page where the fax started to fail, and the entire file is not received by us.


BCBSVT Administrative Changes due to the Coronavirus

March 26, 2020 | Revised: March 30, 2020

On March 25, 2020 Governor Scott issued a stay-at-home order. We’re taking seriously our commitment to keeping Vermont well and slowing the spread of COVID-19. While most of our employees transitioned to work from home last week, effective Thursday, March 26, we’re closing our physical building in its entirety, but remaining fully operational and here to support you during this time.

This is resulting in changes you need to be aware of related to:

  • Do not mail anything to us until further notice
  • Appeals Process
  • Paper Claim Submissions
  • Customer Service inquiries
  • Prior Approval/Pre-Determinations
  • Provider Enrollment and Demographic Changes

Click here for 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.


Temporary/Emergency Policy: Telephone Triage

March 20, 2020 | Updated: March 31, 2020

This new temporary/emergency policy has been updated retroactive to March 13, 2020.

This policy recognizes the influx of calls providers are fielding and allows patient to connect with their providers without going into the providers office. These brief check in service are for patient with an established relationship with a provider and where communication is not related to a medical visit within a previous 7 days and does not lead to a medical visit within the next 24 hours.

Bill with HCPCPS code G2010 or G2012 and Place of Service 02.

Click here to review the full policy. The policy is also posted to the Provider Resource Center under the BCBSVT Policies, Payment Policies link.


Temporary/Emergency Payment Policy: Telephone-Only Services

March 17, 2020 | Updated: April 6, 2020

This new policy is being implemented in the setting of active coronavirus infection with the health service area and in an effort to improve social distancing.

Click here to review the full policy. This policy is also posted to the Provider Resource Center under the BCBSVT Policies, Payment Policies link.


Coronavirus and Interactions with BCBSVT

March 17, 2020

Click here for a recently released letter with the following topics:

  • Temporary/Emergency Payment Policy: Telephone-Only Services
  • Customer Service Team
  • Provider Resource Center (PRC)
  • Acuity Connect
  • What’s New on our Website
  • Appeals (provider on behalf of member)
  • Billing for Coronavirus Testing (COVID-19)

Billing for Coronavirus Testing (COVID-19)

March 17, 2020 | Revised: March 30, 2020

Click here for CDC protocol for billing of the tests and diagnosis codes related to the coronavirus.

For BCBSVT members to receive a zero-cost share for the coronavirus testing, services must be provided in an office (place of service 11), or Urgent Care (place of service 20) or Emergency Room (place of service 23) setting. In addition, one of the following ICD-10-CM codes needs to be reported as the primary diagnosis:

  • Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out
  • Z20.828 Contact with an (suspected) exposure to other viral communicable diseases

The ICD-10-CM code B97.29 (Other coronavirus as the cause of diseases classified elsewhere) should be reserved for patients with confirmed coronavirus and therefore, should not be used for the purposes of screening.

Note: If a practice is doing the interactions/testing in a parking lots/driveways of your property, bill the following Place of Services(POS):

  • Office property POS 11
  • Urgent Care property 20
  • ER property 23

If interaction/testing is being provided in any other location (for example a tent in a shopping plaza) we are requesting claims be submitted with a POS 20.


Appeals (Provider on Behalf of a BCBSVT Member) Change

March 17, 2020

Effective immediately, these appeals need to be faxed to “Attention Appeals” at (866) 617-8969 or emailed to appeals@bcbsvt.com. These are the most reliable, preferred method at this time.

Please be advised, this is for appeals only – benefit, claims or other questions will not be responded to if sent to this fax/email.


In Network Independent Laboratories Providing the Coronavirus (COVID-19) Tests

March 12, 2020 | Revised March 13, 2020 to add Diatherix Laboratories

The following in network, independent laboratories can provide testing for the Coronavirus (COVID019):

  • BioReference Laboratories
  • Diatherix Laboratories
  • Laboratory Services Corporation (LabCorp)
  • Quest Diagnostics

Additional in network laboratories are expected to be added to this list shortly. For the most up to date information, please use the “What’s New” area of the BCBSVT provider website located at bcbsvt.com/provider.

Please direct any questions related to this message to provider relations at providerrelations@bcbsvt.com or phone at (888) 449-0443 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.


New, Revised & Deleted Codes for October 1, 2019 (Adaptive Maintenance)

September 26, 2019

BCBSVT is in the process of completing our review of the HCPCS/CPT® codes additions, deletions and revisions for October 1, 2019. This could result in some changes to:

  • Prior approval
  • Investigational services
  • Unit designation
  • Fee/Allowed Amounts

Click here for full details and a reminder on other changes for November 1, 2019.


ClaimCheck

September 25, 2019

The ClaimCheck software will be upgraded on November 1, 2019. Click here for full details.


Update to MD Rx and HIT

September 24, 2019

BCBSVT completed the analysis of our community fee schedule for NDC for Home Infusion Therapy Services and HCPCS. As a result, there will be some changes in the community fee schedules for HIT and HCPCS that will go into effective for dates of service October 1, 2019 or after.

Click here for full details.


Payment Policy Revision

September 10, 2019

In response to questions and comments from our provider community, we have revised our payment policy for the "Use of Non-Participating Providers" to clarify certain details and our intent.

The updated policy is effective October 15, 2019 and can be located on the secure Provider Resource Center under the link BCBSVT Policies, then Payment Policies. If you require a paper copy, please contact the provider relations team at providerrelations@bcbsvt.com or by phone at (888) 449-0443.


Transitioning of Pediatric Patients

September 10, 2019

We know that transitioning your pediatric patient to their future provider for adult care can be an emotional and sensitive issue. We have advice and tools available to assist you. They are located at bcbsvt.com/provider under the Provider Manual/Handbook & References Guide Link under General - Pediatric Patient Transition Template.


Paper Claims and Member Prefixes

September 10, 2019

Paper Claim Submitters:

The alpha prefix or alpha characters contained with a members identification number must be reports as capital letters on paper claims. If the letter are lower case, they may not be read properly by our scanners and causing claim processing denials or delays. If you have questions, please contact the provider relations team at providerrelations@bcbsvt.com or phone at (888) 449-0443 option 1.


Blood Draw Stations

September 09, 2019

BCBSVT is pleased to let you know members have access to a local, convenient, and cost-effective blood draw station in your community. ClearChoiceMD has partnered with Quest Diagnostics to provide blood draw services in South Burlington, Rutland, Berlin, Brattleboro, and Lebanon, NH. Members must have a Quest lab requisition form, in order to access the draw station. ClearChoiceMD does not perform blood draws for other labs.

Click here for a draft pdf that provides information you can share with your patients.

Quest is printing up tear sheets for provider offices, making it an easy reference guide to give to patients. If you would like to have copies of the final document, please let Quest know. Note that the hours for the Lebanon location are being corrected to 8 am to 7 pm.


Provider Satisfaction Survey 2019

September 09, 2019

It's time for our annual Provider Satisfaction Survey. The release of the survey* is underway. When you receive the survey, we encourage your participation.

By participating in the annual survey you have the opportunity to share with us, from your perspective, what areas we excel in and what areas we need to focus on improving. It also provides you the opportunity to expand beyond the survey questions and share with us any other experiences you have had with BCBSVT over the past 12 months, good or bad.

*The survey is administered by our contracted vendor, SPH Analytics.


Updated Home Birth Payment Policy

August 20, 2019

We have updated and posted the Payment Policy for Home Births on the provider resource center under the BCBSVT Policies link, under Payment Policies, Home Birth. If you need a paper copy, contact the provider relations team at providerrelations@bcbsvt.com or by phone at (888) 449-0443 option 1.


Dry Needling

August 12, 2019

State of Vermont employee's now have some availability for Dry Needling services. Click here for full details.


October 1, 2019 Medical Policy Changes

July 29, 2019

We have reviewed, updated, and created new medical policies that will be effective October 1, 2019. Click here for full details.


State of Vermont Employee Co-Payments

July 25, 2019

State of Vermont Employee's identification cards have created some confusion. Eligible services have a co-payment of either $0, $25 or $30, depending on the service being provided. For example, mental health services have a $0 co-payment, while chiropractic visits have a $25 copay and specialist visits such as nutritional counseling have a $30 copay.

The best way to determine the level of co-payment is by verifying through an eligibly check on the provider resource center, or calling customer service at 800-924-3494.


Job Aides for Real-Time Eligibility Inquiry

July 25, 2019

We have posted job aides on the real-time eligibility page to provide a general overview of how to conduct eligibility requests, as well as how to run specific requests based on provider/facility type.

If you have questions about how to complete an eligibility inquiry or need training, please contact the provider relations team by email at providerrelations@bcbsvt.com or phone at (888) 449-0443 option 1.


Reminder: Independent Laboratory Benefit Manager

July 24, 2019

Effective August 1, 2019 our Lab Benefit Manager (LBM) program with Avalon begins. The LBM manages BCBSVT’s independent laboratory benefit program and laboratory network, providing key services to promote improved clinical outcomes and optimize cost- effective independent laboratory services (place of service 81). You can help in this mission by using (or directing or referring members to) independent laboratory providers that are in BCBSVT’s network.

Click here to view a complete list of contracted independent laboratories as of August 1, 2019

Note: Facility based laboratory services are also available through contracted facilities.

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


MD Rx and HIT Fee Review for October 1, 2019

July 19, 2019

We will be conducting an analysis of our community fee schedule for National Drug Codes (NDC) for Home Infusion Therapy Services and Health Care Procedure Coding System (HCPCS). The focus is for the categories of administrative, miscellaneous, investigational, radiopharmaceuticals, drugs "administered other than oral method", chemotherapy drugs, select pathology, laboratory and temporary codes.

Click here for full details.


Changes in Fraud, Waste and Abuse Phone Lines

July 17, 2019

There are now two different phone numbers to contact our FWA team:

  • Inquiries for BCBSVT members: (833) 225-3810
  • Inquiries for Federal Employee Program members: (800) 337-8440

We have updated our contact information for providers with this change and reposted.


July 11, 2019

BCBSVT is implementing a new payment policy effective September 1, 2019 titled, "Use of Non-Participating Providers." We have posted the policy within our secure Provider Resource Center at www.bcbsvt.com/PRC. We encourage you to review the policy in its entirety, as this change has financial impacts to contracted providers/facilities. Click here to view the complete provider notice.


Prior Approval Lists

July 02, 2019

The prior approval lists have been updated with the July 1, 2019 changes.


New Reference Guide

June 14, 2019

A new reference guide on how to prevent hospital readmissions has been posted to the reference guide and motivational poster area of our provider website. Click here to link to the guide. If you would like a printed copy, contact the Provider Relations Team at (888) 449-0443 and we will mail a supply out to your office.


New, Revised and Deleted Codes for July 1, 2019 (Adaptive Maintenance)

June 13, 2019

BCBSVT is in the process of completing our review of the CPT® and HCPCS additions, deletions and revisions for April 1, 2019. This could result in some changes to:

  • Prior approval
  • Investigational services
  • Unit designation
  • Fee/Allowed Amounts

Click here for full details and a reminder on other changes for July 1, 2019 we previously provided notice on.


BCBSVT initiated adjustments

May 31, 2019

Over the next few weeks, we will be processing corrections within our new claims system. Therefore, you may experience an unusually high volume of claim adjustments.

Some of the adjustments may result in no change in processing. These adjustments report to the provider vouchers as informational. There is no retraction of the original claim or repayment, just a restatement of the original claim processing. Click here for full details.


Updated 2019 Holiday Schedule

May 30, 2019

BCBSVT will be open for business on Friday, June 7, 2019. We have updated our holiday schedule accordingly. Click here to link to the full 2019 holiday schedule.


Continuous Glucose Monitoring (CGM) Products

May 13, 2019

Effective April 10, 2019, prior approval is not required for CGM Products and benefits are available through either a member's pharmacy or medical benefits.


Chiropractic Medical Policy

May 10, 2019

Effective July 1, 2019 there will be changes in Chiropractic Medical Policy, click here for full details.


Acuity Connect Unavailable Times

May 07, 2019

Our on line prior approval tool (for medical services), Acuity Connect, will be unavailable starting at 6 pm, Friday, May 17th and running through 8 am on Monday, May 20, 2019. We apologize for any inconvenience this may cause your practice.

During the unavailable time, if you have a need to submit a prior approval request, you will need to do so on paper, via fax. The form is posted to the prior approval area of our provider website. The fax number to send completed forms is (866) 387-7914.

Prior approval requests for pharmacy services done through Express Scripts, Inc., or radiology services done through AIM Specialty Health will not be impacted by the unavailable time.


ClaimCheck Upgrade in May

April 25, 2019

There are changes in Medical policies and other services that will take effect on July 1, 2019. Click here for full details.


ClaimCheck Upgrade in May

April 04, 2019

The ClaimCheck system will be upgraded on May 10, 2019. Click here for full details.


Updated Prior Approval List

April 04, 2019

The prior approval list has been updated to incorporate the changes effective April 1, 2019. It is posted to the prior approval area of our provider website. Or, if you need a paper copy, contact your provider relations consultant at (888) 449-0443.


April Adaptive Maintenance

March 25, 2019

BCBSVT is in the process of completing our review of the CPT® and HCPCS additions, deletions and revisions for April 1, 2019. This could result in some changes to:

  • Prior approval
  • Informational services
  • Unit designation
  • Fee/allowed amounts

Click here for full details.


Update to MD Rx and HIT

March 11, 2019

BCBSVT completed the analysis of our community fee schedule for NDC for Home Infusion Therapy Services and HCPCS. As a result, there will be some changes in the community fee schedules for HIT and HCPCS that will go into effective for dates of service April 1, 2019 or after.

Click here for full details.


New Claim Processing System

March 11, 2019

BCBSVT transitioned our members to a new claim processing system on January 1, 2019. As a result, claims processing for many claims has slowed down from our usual one-to-two week turn-around time. Most recently you should have noticed an increase in the amount of claims processed, we anticipate increased claim releases over the next few weeks.

Any practice in need of a financial bridge as a result of the lack of claim processing can contact their BCBSVT provider relations consultant at (888) 449-0443 to discuss available options.

Thank you in advance for your patience, understanding and your uninterrupted service to our members. If you have any questions, do not hesitate to contact your provider relations consultant (888) 449-0443.


CBA Blue Prefixes

February 18, 2019

CBA Blue added two prefixes effective January 1, 2019 those are A5L & D3M. They are the first to begin to use the alpha/numeric prefixes. CBA Blue also has two prefixes that will be terminating, those are: LEY (as of 03/01/19) and SQF (as of 06/30/19). If you have any question about CBA Blue contact their customer service team directly at (888) 222-9206 option 3. As a result of these changes, the prefix listing has been updated.

Click here for the updated version.


Change in Reporting of Claims with Mixed Reimbursements

February 15, 2019

Our claim system processes claims containing mixed reimbursements (capitated and fee for service) as two separate claims. Claims are automatically broken out; one claim is generated for the services that receive the capitated reimbursement and the other claim is for the services that reimburse as fee for service.

Click here for full details.


AIM Provider Portal

February 14, 2019

If you customized your favorites in the AIM Specialty Health Provider Portal for BCBSVT, you will need to recreate your favorites on/after Monday, February 25, 2019.

Click here for full details.


2019 Holiday Schedule

February 07, 2019

We have revised the 2019 Holiday Schedule. Click here for a copy.


COBA and the FEP Program

February 04, 2019

FEP claims now cross over from Medicare. Do not submit claims, unless the MEOP advised the claim did not cross over, or it has been 30 days since Medicare crossed it over to FEP for processing. Click here for full details.


Provider Vouchers - Member ID's Reporting a XXXXXXXXX

January 31, 2019

On your January 22, 2019 provider voucher, you may experience some invalid/unknown ID numbers (unknown to BCBSVT – invalid membership/no membership on file) are blocked out with XXXXXXXXX. Due to an error in our logic, the ID number submitted to BCBSVT was detected as a possible security violation and therefore, X's were reported to protect the ID number from being distributed any further.

We have updated the logic in our system, so you will only experience this on a January 22, 2019 provider voucher.

If you have any questions, please contact your provider relations consultant.


April 1, 2019 Changes

January 29, 2019

There are several changes occurring effective April 1, 2019, such as:

  • Updates to Provider Audit, Sampling & Extrapolation & Re-Audit Policy
  • Medical Policies: new, revised, archived and updated
  • Change in requirements for certain services

Click here to link to the complete notice that provides details.


MD Rx and HIT Fee Schedule Review

January 28, 2019

BCBSVT will be conducting analysis of our community fee schedule for NDC for Home Infusion Therapy Services and HCPCS. The focus is for the categories of administrative, miscellaneous, investigational, radiopharmaceuticals, drugs "administered other than oral methods," chemotherapy drugs, select pathology, laboratory and temporary codes.

Click here for full notice.


Billing of Anesthesia After January 1, 2019

January 25, 2019

Anesthesia services rendered January 1, 2019 or after must be billed reporting minutes.

Full details related to billing of anesthesia services are available in our on-line provider handbook in section 6.7, located in the provider link at bcbsvt.com, or by contacting your provider relations consultant.

Claims for anesthesia services, regardless of length of time, can be submitted to BCBSVT for consideration.


Radiology PA for NEHP/ABNE

January 25, 2019

New England Health Plan(NEHP)/Access Blue New England (ABNE) members have the same prior approval requirements for advanced imaging as Blue Cross and Blue Shield of Vermont members and prior approval requests are submitted to BCBSVT. Click here to see the full notice.


Updated Prefix Listing

January 21, 2019

The 2019 prefix listing for BCBSVT, New England Health Plan, Access Blue New England and CBA Blue has been posted to the Provider Manual/Handbook and Guidelines link.


Membership Denials

January 21, 2019

Denial of claims on provider voucher/835's for lack of membership (BCBSVT members only):

  • Provider Voucher, in some cases, will report back the ID number with a V, even if the V was not submitted on the claim; review the original claim submission and follow up appropriately.
  • Some of the denials are due to timing. membership was not loaded in time for claim processing, and therefore denied incorrectly. Please submit the claim(s) again for processing.

Click here for full details. If you have any questions, please contact your provider relations consultant at (888) 449-0443.


Who is a BCBSVT Member

January 18, 2019

As you are aware, ALL BCBSVT members had a change in identification number that was effective on January 1, 2019.

We have received several inquiries asking who exactly is a BCBSVT member, so the news item is to clarify.

It is easier to advise who is not a BCBSVT member, so: BCBSVT members DO NOT include:

  • Federal Employee Program
  • BlueCard
  • New England Health Plan
  • Access Blue New England.

We manage/process the claims but they are not truly our members.

As an additional note: CBA Blue is not BCBSVT. As a disclaimer, other Blue Plans may have changes in prefix/ID numbers but it would be completely unrelated to the change BCBSVT made and would not mirror what BCBSVT has done for the new ID.

If you have any question, please contact the provider relations team at (888) 449-0443 or by email at providerrelations@BCBSVT.com.


Viewing Prior Approvals

January 14, 2019

Need to review a prior approval that was granted prior to January 11, 2019? They are not available in Acuity Connect but can be found by going into the link on the Acuity Connect link where it states. Alternatively, if you need to review an authorization, go here. Simply click on the link and complete your search.

If you have any questions, please contact the Provider Relations team at (888) 449-0442.


Acuity Connect

January 11, 2019

BCBSVT Acuity Connect (on-line prior approvals) Users:

We are experiencing a high volume of requests which is causing the Acuity Connect system to slow down. As a result, you may experience a delay in response or "spinning." We apologize and are working to correct the issue. We will post an updated news item once the issue is resolved.