Volume 17, 2011

Issue 37 - 2012 Fee Schedule Update
Effective April 1, 2012, the BlueCross BlueShield of Western New York Standard Fee Schedule will be updated.
Issue 36 - Medical Protocol Update Digital Breast Tomosynthesis
Digital Breast Tomosynthesis (three-dimensional mammogram), a new protocol recently posted to our provider website, has a change effective January 15, 2012
Issue 35 - HPV Vaccine Recommended for Boys and Young Men
HPV vaccine recommended to help reduce transmission and prevent HPV-related conditions.
Issue 34 - Drug Therapy Guideline Updates
Updated Drug Therapy Guidelines effective January 1, 2012.
Issue 33 - Behavioral Health: Timely Follow up Requirements
Effective December 1, 2011, BlueCross BlueShield of Western New York will require participating facilities to ensure that all members exiting a behavioral health disorder program have an outpatient appointment scheduled within seven calendar days of the discharge date.
Issue 32 - Oxygen and Oxygen Supplies
Effective January 1, 2012 a revised reimbursement methodology for oxygen and oxygen-related supplies will be implemented.
Issue 31 - Important Update: 2012 HEDIS Changes
The enclosed documentation contains changes and two new measures for the 2012 Health Plan Employer Data Information Set.
Issue 30 - Fee Schedule Update: DME and Orthotic/Prosthetic
Effective January 1, 2012, the BlueCross BlueShield of Western New York commercial and Medicare Advantage fee schedules for durable medical equipment (DME) and orthotic and prosthetic (O&P) codes will be updated to more closely align with the prevailing Medicare rates.
Issue 29 - Durable Medical Equipment Repairs and Parts Replacement
Effective October 1, 2011, BlueCross BlueShield of Western New York will utilize Medicare's policy guidelines when considering repair and/or part replacement of durable medical equipment (DME) for reimbursement.
Issue 28 - Benefit Change for Medicaid and Family Health Plus Members
Effective October 1, 2011, BlueCross BlueShield of Western New York will begin managing the prescription benefit for our Medicaid managed care and Family Health Plus members in conjunction with MEDCO, our pharmacy benefit administrator.
Issue 27 - Anesthesia for Bronchoscopy and Pain Procedures
Effective October 1, 2011, BlueCross BlueShield of Western New York will require preauthorization for anesthesia services for diagnostic or therapeutic bronchoscopy and interventional pain procedures.
Issue 26 - Anesthesia for Bronchoscopy and Pain Procedures
Effective October 1, 2011, BlueCross BlueShield of Western New York will require preauthorization for the use of anesthesia services or monitored anesthesia care (MAC) during bronchoscopy and interventional pain procedures when administered by an anesthesia provider.
Issue 25 - Guideline Update: Cardiac PET Scan
Effective November 15, 2011, an updated Cardiac PET guideline will be in place. This update is based on the American College of Cardiology (ACC) Appropriateness Criteria, the consensus standard for clinical guidelines.
Issue 24 - Drug Therapy Guideline Update: Cimzia
Effective September 15, 2011, this update is a result of the annual guideline review and new drug evaluations performed quarterly by our Pharmacy and Therapeutics Committee.
Issue 23 - Cosmetic Services Update
Effective October 1, 2011, reimbursement for the Current Procedural Terminology (CPT) codes will be as defined in this bulletin.
Issue 22 - Drug Therapy Guideline Updates
Effective September 1, 2011, these updates are a result of the annual guideline review and new drug evaluations performed quarterly by our Pharmacy and Therapeutics Committee.
Issue 21 - Fee Schedule Update: Cardiac Catheterization Procedures
As a result of a recent analysis of our 2011 Standard Fee Schedule, effective July 1, 2011, reimbursement for the following Current Procedural Terminology (CPT) codes will be as described in this bulletin.
Issue 20 - Patient Centered Medical Home After-Hours Initiative
The Patient-Centered Medical Home (PCMH) model supports quality, safety and increased access for patients.
Issue 19 - Fee Schedule Update: Radiopharmaceuticals
Effective September 1, 2011, radiopharmaceuticals will be priced with the following methodology: average wholesale price minus 15 percent (AWP-15%).
Issue 18 - Pay for Performance Update
Effective August 2011, the Pay for Performance program will be updated as explained within.
Issue 17 - Imaging Accreditation Standards Update
Effective July 1, 2011, BlueCross BlueShield of Western New York's imaging services standards will be updated to include standards developed by the IAC.
Issue 16 - Drug Therapy Guideline Updates
As of July 1, 2011, these Drug Therapy Guideline updates will be effective.
Issue 15 - Drug Therapy Guideline Updates
As of July 1, 2011, these Drug Therapy Guideline updates will be effective.
Issue 14 - Drug Therapy Guideline Updates
As of June 1, 2011, these Drug Therapy Guideline updates will be effective.
Issue 13 - 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 April 1, 2011.
Issue 12 - Fee Schedule Update: Radiopharmaceuticals
Effective July 1, 2011, all radiopharmaceuticals will be priced with the following methodology: average wholesale price minus 15 percent (AWP-15%).
Issue 11 - Medical Injectable Reimbursement Changes
Effective July 1, 2011, there will be a change in our reimbursement methodology for provider-administered medical injectable drugs.
Issue 10 - New Provider Demographic Change Form
All providers are contractually obligated to promptly notify BlueCross BlueShield of Western New York in writing if there are any changes to their practice.
Issue 09 - Updated Drug Therapy Guidelines
As of April 1, 2011, these updated Drug Therapy Guidelines will be effective.
Issue 08 - BlueSaver Medical Savings Account FAQ
Questions from providers about this new product have been compiled in this FAQ guide.
Issue 07 - Preventive Services
As of January 1, 2011, this list of preventive services do not require a copay from Medicare Advantage members.
Issue 06 - Info Updates Regarding the CMS Medicare Advantage Appeal
Directors of utilization review and/or case management departments and associated staff should read this updated information about Medicare Advantage Appeal Notices from CMS.
Issue 05 - National Consumer Cost Tool
We are pleased to announce the launch of the National Consumer Cost Tool (NCCT) that will be available to other BlueCross BlueShield plan members as of January 1, 2011.
Issue 04 - Updated Drug Therapy Guidelines
As of March 1, 2011, the attached Drug Therapy Guidelines will be effective. These updates are a result of the annual guideline review and new drug evaluations performed by our quarterly Pharmacy and Therapeutics Committee.
Issue 03 - OncologyConnections Program for Providers & Facilities
Effective, March 1, 2011, NIA will begin providing utilization management services for outpatient radiation therapy treatment for breast, prostate, lung, colon, and rectal cancer.
Issue 02 - OncologyConnections Program for all Radiation Oncologists
Effective, March 1, 2011, NIA will begin providing utilization management services for outpatient radiation therapy treatment for breast, prostate, lung, colon, and rectal cancer.
Issue 01 - Get Ready for Version 5010
There is less than a year left to prepare for the Version 5010 transaction set change on January 1, 2012. Have you started to prepare for the transition?