Volume 15, 2009

Issue 46 - Claims Appeal Update
In an effort to improve provider satisfaction and provide an enhanced and more efficient claims experience, we are pleased to announce significant changes to the claims appeal process.
Issue 45 - 2010 Behavioral Health Fee Update
Following careful consideration over the past several months, we are pleased to announce that the Behavioral Health fee schedule will increase by 2.94 percent in the aggregate effective January 15, 2010.
Issue 44 - 2010 Fee Schedule Update
Following careful consideration over the past several months, we are pleased to announce that our revised fee schedule will become effective January 15, 2010.
Issue 43 - Renewing Behavioral Health Preauths
The following is important information for providers regarding the renewal of preauthorization for Behavioral Health services in the new year.
Issue 42 - NASCO Auto Accounts Claims to be Processed Through BlueCard
Effective January 1, 2010 claims for General Motors, Delphi, Ford, United Auto Workers (UAW) and American Axle groups submitted January 1, 2010 or later will be processed through the BlueCard® system.
Issue 41 - Respiratory Syncytial Virus
This bulletin contains important information regarding prophylactic treatment for high-risk patients.
Issue 40 - Durable Medical Equipment (DME) Update
Effective January 1, 2010 BlueCross BlueShield will implement a revised reimbursement for HCPCS code E0570.
Issue 39 - Federal Mental Health Parity
Congress enacted the Pete Domenici and Paul Wellstone Mental Health Parity and Addiction Equity Act as part of the Emergency Economic Stabilization Act, which affects coverage of mental health and substance abuse services, on October 3, 2008.
Beginning October 30, 2009, any WNYHealtheNet registered user will automatically be registered to access www.bcbswny.com.
Issue 37 - Cosmetic Services Update
Effective November 1, 2009, benefits for cosmetic services performed by non-physician professionals are subject to the following conditions in order to be considered for payment/reimbursement.
Issue 36 - Monroe Plan to Administer Case and Disease Management
Effective September 1, 2009, BlueCross BlueShield of Western New York began partnering with the Monroe Plan for Medical Care.
Issue 35 - Recent Formulary Updates on Our Web Site
BlueCross BlueShield of Western New York is pleased to announce that we have updated our web site!
Issue 34 -
BlueCross BlueShield of Western New York is implementing a preauthorization program for prostate biopsies as part of an enhanced quality assurance process.
Issue 33 - Health Care Reform
As you know, health care reform is currently at the forefront of American domestic policy debate and it’s important that you know where BlueCross BlueShield of Western New York stands on this issue.
Issue 32 - Anesthesia for Upper and Lower Gastro Procedures - Hospital
Effective September 1, 2009, BlueCross BlueShield of Western New York will require preauthorization for anesthesia services for diagnostic or therapeutic endoscopic procedures.
Issue 31 - Anesthesia for Upper and Lower Gastrointestinal Procedures
Effective September 1, 2009, BlueCross BlueShield of Western New York will require preauthorization for the use of anesthesia services or monitored anesthesia care as follows.
Issue 30 - Sacroiliac Joint Arthrography & Injection
Effective September 1, 2009, the following CPT and HCPCS procedure codes will be considered Experimental/Investigational...
Issue 29 - Multiple Imaging Code Edit Change
Effective September 15, 2009, a claim process change resulting in a coding edit for the technical component (TC) of multiple imaging services for CT, CTA, MRI, MRA and non-obstetrical ultrasound codes will be implemented.
Issue 28 - v15i28 Pricing for Laser Procedures and Chemical Peels
As previously stated in STAT Bulletins dated December 14, 2007 (Volume 13: Issue 30) and February 19, 2008 (Volume 14: Issue 4), laser procedures for all Traditional contracts with a “Cosmetic Rider” require clinical review of supporting documentation.
Issue 27 - v15i27 Affordability Update
Accelerating cost trends, as well as the economic recession and the unplanned increased New York State assessment on health insurers have resulted in significant impact on BlueCross BlueShield of Western New York.
Issue 26 - Billing Bilateral and Multiple-Unit Procedures
In accordance with Current Procedural Terminology (CPT) guidelines, bilateral procedures should be billed on one line only, utilizing the modifier 50; enter one as 01 in the units field and bill your total bilateral charge.
Issue 25 - Paperless Claims
To further enhance BlueCross BlueShield of Western New York’s Paperless Initiative and assist our providers in the submission of electronic claims, we are pleased to provide you with the following information.
Issue 24 - Credentialing and Recredentialing Through CAQH
Effective August 1, 2009, all providers not currently using CAQH will be required to enter their credentialing information (free of charge) into a secure, state-of-the-art data center.
Issue 23 - Pay for Performance Program Update
We are pleased to announce that we are making significant changes to our Physician Incentive Program effective July 1, 2009.
Issue 22 - Epidural Injections
Effective July 15, 2009, BlueCross BlueShield of Western New York will require preauthorization for all epidural injection procedures beyond the standard treatment of three injections within 12 months.
Issue 21 - Elective Cardiac Catheterization Preauthorization
To ensure the highest quality treatment in a cost-effective manner, BlueCross BlueShield of Western New York is implementing a preauthorization program to screen for the medical indications for elective cardiac catheterization.
Issue 20 - Manipulation Under Anesthesia
BlueCross BlueShield of Western New York will now require preauthorization for Manipulation Under Anesthesia (MUA) for procedures scheduled on or after July 15, 2009.
Issue 19 - Implantable Cardioverter Defibrillators
To ensure the highest quality treatment in a cost-effective manner, BlueCross BlueShield is implementing a preauthorization program to screen for the medical indications for implantable cardioverter defibrillators.
Issue 18 - New Billing Guidelines for Home Infusion and Updated Fees
New Billing Guidelines for Home Infusion, Enteral and Parenteral Therapies and Home Infusion Fee Schedule Effective July 1, 2009.
Issue 16 - Oxygen and Oxygen-Related Supplies
Effective July 1, 2009, BlueCross BlueShield of Western New York will be implementing a revised reimbursement methodology for oxygen and oxygen-related supplies/services for all lines of business.
Issue 15 - Changes to Provider Call Center Hours of Operations
Effective Monday, April 27, 2009, the Provider Call Center Service hours are changing.
Issue 14 - Preauthorization Required for Erectile Dysfunction (ED) Procedures
Providers must report the applicable CPT/HCPCS/ICD-9 codes when requesting preauthorization or billing erectile dysfunction services for Healthy NY members.
Issue 13 - Maternity Physician Practice Guidelines Update
BlueCross BlueShield of Western New York has adopted the recommendations published by the New York State Department of Health (NYSDOH) for maternity care.
Issue 12 - Never Events and Hospital Acquired Conditions
Effective October 1, 2008, BlueCross BlueShield of Western New York required a 'Present on Admission' (POA) value on all claim submissions from acute care hospitals.
Issue 11 - 2009 Paperless Initiative
BlueCross BlueShield is pleased to announce that we are kicking off our 2009 Paperless Initiative.
Issue 10 - PT Fee Increase Correction
The information contained in this STAT Bulletin serves as a correction to STAT Bulletin Vol. 15, Issue #3, published January 15, 2009, regarding reimbursement for physical and occupational therapy services.
Issue 9 - Office Based Surgery Accreditation
Effective July 14, 2009, BlueCross BlueShield of Western New York will adhere to the New York State Department of Health statute regarding office-based surgery accreditation.
Issue 8 - Focused Management of Medication
Current Procedural Terminology and Healthcare Common Procedure Coding System Level II standards provide two codes for billing services focused on the management of psychiatric or chemical dependency medications.
Issue 7 - Durable Medical Equipment Benefit Update
During the past few years, Durable Medical Equipment (DME) benefits have changed for many of our members. Effective March 1, 2009, some DME codes will be removed from the Prior Authorization Required Guide.
Issue 6 - Effective March 1, 2009, Home Health Aide (HHA) services will no longer require prior authorization for our members, with the exception of Healthy NY and select Administrative Services Only (ASO) contracts.
Effective March 1, 2009, Home Health Aide (HHA) services will no longer require prior authorization for our members, with the exception of Healthy NY and select ASO contracts
Issue 5 - Revised Fee Schedule for Orthotic and Prosthetic Codes
Effective March 1, 2009, BlueCross BlueShield of Western New York will implement reimbursement of HCPCS (Healthcare Common Procedure Coding System) “L” codes based on the Medicare-based methodology of January 1, 2008.
Issue 4 - Prior Authorization Requirement for Cervical / Lumbar Fusion
Effective March 1, 2009, cervical and lumbar fusion surgeries will require prior authorization to determine medical necessity. InterQual guidelines are utilized in making medical necessity determinations.
Issue 3 - Reimbursement Increase for Physical and Occupational Therapy
We are pleased to announce that effective January 15, 2009, reimbursement increases will be applied to Physical and Occupational Therapy services for the following services and lines of business.
Issue 2 - Inpatient Preauthorization Requirement Removed Acute Care
In an effort to further reduce the administrative burdens placed on our providers, we are pleased to announce that effective February 15, 2009, facilities will no longer be required to obtain prior approval for admissions.
Issue 1 - Inpatient Preauthorization Requirement Removed
In an effort to further reduce the administrative burdens placed on our providers, we are pleased to announce that effective February 15, 2009, providers will no longer be required to obtain prior approval for inpatient admissions.