Volume 16, 2010

Issue 34 - 2011 Fee Schedule Update
This bulletin contains important information regarding upcoming fee schedule changes for BlueCross BlueShield of Western New York.
Issue 33 - Pharmacy Guideline Updates
As a result of the quarterly review performed by our Pharmacy and Therapeutics Committee, the following Pharmacy Guideline changes will become effective February 1, 2011.
Issue 32 - Medicare Part B Drug Claims
As an essential partner in our members’ health care, BlueCross BlueShield of Western New York wants you to be aware of an important change specific to the processing of Medicare Part B drug claims (usually J codes), effective January 1, 2011.
Issue 31 - Announcing a New Medicare Advantage Product for 2011
The new BlueSaver MSA plan combines a high deductible plan with a medical savings account that Medicare Advantage members can use to pay for their health care costs while meeting their annual deductible of $4,000.
Issue 30 - Durable Medical Equipment Update
The updated Durable Medical Equipment (DME), Prosthetic and Orthotic preauthorization requirements for BlueCross BlueShield of Western New York are effective January 1, 2011.
Issue 29 - 2010 Quality Compliance Reports Now Available Online
BlueCross BlueShield of Western New York is pleased to announce that the Quality Compliance Reports for the first half of 2010 are now available on our secure provider web site at www.bcbswny.com.
Issue 28 - Pharmacy and Medical Guideline Updates
The attached Pharmacy and Medical Guideline updates are effective December 1, 2010. These updates are a result of the annual guideline review and new drug evaluations performed quarterly by our Pharmacy & Therapeutics Committee.
Issue 27 - Appropriate Use of Modifiers
Providers are reminded to adhere to the Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) guidelines when billing, regardless of reimbursement potential.
Issue 26 - New HIV Testing Law in New York State
Effective September 1, 2010, the new law will provide significant changes in human immunodeficiency virus (HIV) testing guidelines in New York state.
Issue 25 - Patient-Centered Medical Home
Beginning in 2011, BlueCross BlueShield of Western New York will provide enhanced per member per month (pmpm) payments ranging from $.50 to $2.00 pmpm (for most lines of business) to any practice that has attained Level One, Two or Three Recognition by NCQA.
Issue 24 - Hospice Billing Change for Medicare Advantage
Effective November 1, 2010, BlueCross BlueShield of Western New York expects all providers to comply with the new billing practice outlined in the CMS publication and summarized below.
Issue 23 - Preauth Requirements Change Reminder
Effective June 30, 2010, preauthorization of the first 20 outpatient treatments/visits mental health or substance abuse services is no longer required for most contracts.
Issue 22 - Breastfeeding Mothers’ Bill of Rights
Effective May 1, 2010, the New York State Legislature passed the Breastfeeding Mothers’ Bill of Rights. The intent is to provide complete information regarding the health benefits of breastfeeding so that mothers can make an informed choice.
Issue 21 - Behavioral Health Fee Schedule Increase
BlueCross BlueShield of Western New York is pleased to announce an increase in the corporate behavioral health fee schedules effective with dates of service on or after July 1, 2010.
Issue 20 - Pharmacy and Medical Guideline Updates
As a result of the annual guideline review performed by our Pharmacy & Therapeutics Committee, attached to this bulletin are Pharmacy and Medical Guideline updates effective September 1, 2010.
Issue 19 - Medical Services Protocol Update
Clinical Protocol updates which include information about changes made to some of our Protocols after a recent review.
Issue 18 - Preferred Viscosupplementation Therapy Update
Preferred Viscosupplementation Therapy Update Effective immediately, Euflexxa®, Synvisc®, and Synvisc-One® are the preferred agents under BlueCross BlueShield medical coverage. Current preauthorization requirements remain in effect.
Issue 17 - Back Care Program to Begin in August
Back Care Program to Begin in August In order to meet the needs of our members who suffer from chronic back pain, we have created a comprehensive case and disease management program.
Issue 16 - Medical Services Protocol Update
Medical Services Protocol Update Effective August 1, 2010, BlueShield of Northeastern New York has a new protocol that states scintimammography or breast-specific gamma imaging (BSGI) is investigational for all applications.
Issue 15 - Preauthorization Requirement
Preauthorization Requirement BlueCross BlueShield of Western New York is pleased to announce that, effective June 30, 2010, preauthorization of the first 20 outpatient mental health or substance abuse services is no longer required for most contracts.
Issue 14 - Pharmacy and Medical Guideline Updates
These Pharmacy and Medical Guideline updates will become effective as of July 1, 2010.
Issue 13 - Pay for Performance Update
Pay for Performance Update We are pleased to announce that your Quality Compliance Reports are now available on our secure provider web site.
Issue 12 - Updated Timely Filing Policy
The following is important information regarding recent New York State Managed Care regulations.
Issue 11 - Lead Screening Tests
Lead Screening Tests BlueCross BlueShield of Western New York will provide reimbursement for "point-of-care" blood testing for lead in children less than six years of age and pregnant women when performed by participating providers with the appropriate certification.
Issue 10 - Cosmetic Services Update
Cosmetic Services Update The following bulletin applies to services that are eligible for coverage under a cosmetic rider.
Issue 09 - Pay For Performance Update
The following bulletin contains important information regarding updates to the Pay for Performance program.
Issue 08 - 2010 Fee Schedule Update
The following bulletin contains information regarding BlueCross BlueShield of Western New York’s upcoming fee schedule changes.
Issue 07 - Medical Services Protocol Updates
This clinical Protocol update includes information on a Protocol that has recently had an annual review resulting in a revision to the guidelines. This summary also includes a new Protocol.
Issue 06 - Computer-Assisted Surgical Navigation Procedures
This notice contains important information regarding Computer-Assisted Surgical Navigation Procedures.
Issue 05 - Cosmetic Services Update
The following bulletin applies to services that are eligible for coverage under a cosmetic rider.
Issue 04 - Maternity Physician Practice Guidelines Update
This notice contains important information regarding Agency for Healthcare Research and Quality recommendations.
Issue 03 - Updated Registration Process for Hospital-Based Practitioner
The following information is provided as a courtesy in order to make it easier for non-credentialed practitioners to participate with BlueCross BlueShield of Western New York.
Issue 02 - New Online Reports Available
BlueCross BlueShield of Western New York is pleased to announce that on Friday, January 22, 2010, two reports will be available via our secure provider web site.
Issue 01 - Prior Authorization Required for Hospital Admittance
Effective February 15, 2010, all hospital admissions and confinements will be subject to preauthorization and medical review.