Volume 14, 2008

Issue 23 - Clarification of Program Requirements for Behavioral Health
The following bulletin contains important information and clarification of program requirements for all behavioral health providers regarding Medical Necessity Determinations and Rights of Appeal and is effective 30 days from notification.
Issue 22 - Important Updates for Dental Providers
Important Updates for Dental Providers
Issue 21 - 2009 Fee Schedule Update
BlueCross BlueShield of Western New York performs an annual assessment of our fee schedule and reimbursement methodology.
Issue 20 - Respiratory Equipment Update
Effective January 1, 2009, BlueCross BlueShield of Western New York will implement changes for CPAP (E0601RR), BiPAP-S (E0470RR) and BiPAP-ST (E0471RR).
Issue 19 - Present on Admission Indicator Needed for Claims
Effective January 1, 2009, BlueCross BlueShield of Western New York will now require present on admission (POA) values on all claim submissions from Behavioral Health Facilities.
Issue 18 - Risk Adjustment Chart Review
BlueCross BlueShield of Western New York, in cooperation with The Centers for Medicare and Medicaid Services (CMS), asks you to help us complete an important review that will ensure you receive accurate reimbursements for the services administered to your patients.
Issue 17 - Medicare Part B Contract Enforcement
Members who have Medicare as their primary insurer and BlueCross BlueShield as secondary coverage must enroll in a Medicare Part B plan in order to receive their complete benefits.
Issue 16 - New Program Coincides with World COPD Day
BlueCross BlueShield of Western New York announces a new chronic obstructive pulmonary disease (COPD) program within its Disease Management services to help improve outcomes for its members.
Issue 15 - Clinical Trials
Effective October 1, 2008, routine services for (or associated with) qualifying clinical trials are eligible for coverage.
Issue 14 - Orchard Park Central School District Benefit Reminder
For certain group members and services, a copay is not required for both Primary Care Provider and Specialist visits for dependents under age 19 as of February 1, 2008.
Issue 13 - Radiation Safety Awareness Initiative for ER
We are pleased to inform you that BlueCross BlueShield of Western New York will begin a Radiation Safety Awareness Initiative in September in conjunction with National Imaging Associates.
Issue 12 - Radiation Safety Awareness Initiative
We are pleased to inform you that BlueCross BlueShield of Western New York will begin a Radiation Safety Awareness Initiative in September in conjunction with National Imaging Associates.
Issue 11 - Present on Admission (POA)
Effective October 1, 2008, BlueCross BlueShield of Western New York will now require Present on Admission (POA) values on all claim submissions from Acute Care Hospitals.
Issue 10 - 2008 – 2009 Vaccine Reimbursement Update
BlueCross BlueShield of Western New York is pleased to announce that we will begin to reimburse for the following vaccine administration CPT codes when billed with an evaluation and management service.
Issue 9 - Same Sex Spousal Policy
Issue 8 - Hearing Aid Benefit Change for Select Ford Contracts
Effective July 1, 2008, hourly retirees, surviving spouses and their eligible dependents in Ford Motor Company’s National PPO Program and Blue Preferred PlusSM (Michigan) PPO plans will no longer have hearing aid coverage through BlueCross BlueShield of Western New York.
Issue 7 - Updates to 2008 Fee Schedule
BlueCross BlueShield recently completed an analysis of our 2008 Standard Fee Schedule. As a result, effective June 1, 2008 our reimbursement for the following CPT codes will be updated.
Issue 6 - Gastroenterology Reimbursement Update
Gastroenterology Reimbursement Update
Issue 5 - Coding Update: Rapid Strep Test
As a reminder to our providers, there are only two codes that should be used for rapid strep testing in an office setting.
Issue 4 - Update on Laser Procedure Reimbursement
Stat Bulletin, Volume 13: Issue 30, sent on December 14, 2007, outlined limitations on laser hair removal and phototherapy. Effective immediately, the limitations will be removed.
Issue 3 - Update to Part D Covered Vaccines and Administration
We recently advised you in Volume 13, Issue 32, that in 2008, CMS requires some vaccines and the administration fees associated with them to be covered under Part D, instead of Part B.
Issue 2 - Revised Medicare Advantage Appeal Notices
The information in this bulletin is suggested to be reviewed by Directors of Utilization Review and/or Case Management Departments and associated staff.
Issue 1 - Disease Management Program to be Administered by Alere for Senior Blue and Traditional Blue Medicare PPO Products
As part of our continuing effort to provide the highest quality healthcare coverage, BlueCross BlueShield is pleased to announce a disease management program for our Medicare Advantage members.