Volume 18, 2012

Issue 40 - 2013 Fee Schedule Update
Effective April 1, 2013, the BlueCross BlueShield of Western New York Standard Commercial Fee Schedule will be updated.
Issue 39 - Policy Reminder for Imaging Providers
This is a reminder that the imaging moratorium remains in effect.
Issue 38 -Transition of Benefits Administration
Effective January 1, 2013, BlueCross BlueShield of Western New York will administer the wellness benefits for our members.
Issue 37 - Diabetes Treatment Intervention
BlueCross BlueShield of Western New York wants to help improve outcomes for Medicare Advantage and Medicare Prescription Drug Plan patients with diabetes.
Issue 36 - Chiropractic Transition
As a reminder, effective January 1, 2013, BlueCross BlueShield of Western New York will administer the chiropractic benefits for our members.
Issue 35 - Accredo
Accredo — Express Scripts® Specialty Pharmacy — is now your source for medical benefit drugs administered in your office.
Issue 34 - Medicaid and Family Health Plus Pharmacy Update
Effective November 19, 2012, specialty medications will once again need to be obtained only through Accredo for Medicaid and Family Health Plus members.
Issue 33 - DrugTherapyGuidelines Available on our Website
As a result of the annual guideline review and new drug evaluations performed quarterly by our Pharmacy and Therapeutics Committee, the enclosed updated Drug Therapy Guidelines will be effective as of December 15, 2012.
Issue 32 - NYS Mandate: Annual Physical
New York state recently passed a law requiring insurance companies to allow one routine physical exam or one well-care visit per calendar year.
Issue 31 - National Drug Code Required for Medicaid Managed Care & Family Health Plus Claims
As of September 20, 2012, a New York state mandate requires providers to report the National Drug Code (NDC) when billing for physician-administered drugs for Medicaid Managed Care and Family Health Plus patients.
Issue 30 - Genetic Testing for Inherited Thrombophilia
We want to keep you updated about a medical protocol that will be effective soon.
Issue 29 - Medicaid and Family Health Plus Pharmacy Update
Medicaid and Family Health Plus members can now obtain their specialty medications from more providers due to a New York State Department of Health change.
Issue 28 - Important Durable Medical Equipment, Prosthetic, and Orthotic Information
We are updating our Durable Medical Equipment (DME) and Orthotic and Prosthetic fee schedules for 2013.
Issue 27 - Medco to Change Name to Express Scripts
Effective September 1, 2012, Medco® will be Express Scripts®.
Issue 26 - A Care Coordination Program
We are offering you an opportunity to participate in a new care coordination program.
Issue 25 - Drug Therapy Guideline Updates Available on our Website
As a result of the annual guideline review and new drug evaluations performed quarterly by our Pharmacy and Therapeutics Committee, the enclosed updated Drug Therapy Guidelines will be effective as of September 15, 2012.
Issue 24 - Radiation Therapy Clinical Guidelines Update
Radiation Therapy Clinical Guidelines have been updated and will be effective September 1, 2012.
Issue 23 - Decreasing Hospital Readmissions through Care Coordination
We have developed our third Patient-Centered Medical Home (PCMH) incentive: Care coordination of patients after inpatient hospitalization.
Issue 22 - Provider Data Update Requirement
During a standard review of provider files, it was discovered that you are listed under a group practice instead of as a solo practitioner.
Issue 21 - Billing Requirements for Ancillary Claim Services
In order to standardize claim filing procedures, regardless of your location, for durable medical equipment, independent clinical lab, and specialty pharmacy claims, the BlueCross BlueShield Association requires all Blues plans to comply with the following billing mandates.
Issue 20 - Medicaid Managed Care Expanded Enrollment
Effective February 15, 2012, we will begin a two-step review process for elective inpatient hospital procedures.
Issue 19 - Patient Reviews: Online Survey
This July, we will launch a Patient Reviews survey within the Provider Search function on our website. This will make it possible for members to provide feedback on their experiences with doctors, dentists, and other health care professionals.
Issue 18 - Introducing Our New Website!
On July 1, 2012, the new BlueCross BlueShield of Western New York website will make its’ debut.
Issue 17 - Paperless Initiative: Dental Claims
BlueCross BlueShield of Western New York’s paperless initiative now includes the submission of electronic dental claims.
Issue 16 - Dental Providers: Credentialing and Recredentialing through CAQH
Effective August 1, 2012, all dental providers are required to enter their credentialing information (free of charge) in the secure online data center at the Council for Affordable Quality Healthcare (CAQH) website.
Issue 15 - Billing and Reimbursement of Prostate Biopsy Services
Effective September 1, 2012, the global reimbursement for professional pathology services for prostate biopsy codes 88305 and 88307 will be capped at nine units.
Issue 14 - Reimbursement Change: Sclerotherapy Service
Effective September 1, 2012, reimbursement fees for sclerotherapy services will change.
Issue 13 - Notice of Government Programs Dental Vendor
Effective July 1, 2012, we are partnering with Healthplex to handle the dental benefits for our government program members.
Issue 12 - Drug Therapy Guideline Updates
Drug therapy guideline updates effective June 15, 2012.
Issue 11 - High Risk Medications
The Pharmacy Quality Alliance has determined that the medications on the enclosed list have the highest risk of side effects for elderly patients.
Issue 10 - Fee Update_Balloon Sinuplasty
Codes reimbursed according to a site-of-service differential will be updated on August 1, 2012.
Issue 09 - CMS Medicare Advantage Appeal Notice Update
Directors of utilization review and/or case management departments should be familiar with the updated information about Medicare Advantage Appeal Notices from the Centers for Medicare and Medicaid Services (CMS).
Issue 08 - Medical Protocols Updates
Effective May 1, 2012, three Medical Protocols have changes.
Issue 07 - Reimbursement Changes: Medical Injectables
Effective July 1, 2012, we will add a fourth tier to our reimbursement methodology for provider-administered medical injectable drugs.
Issue 06 - Quest Diagnostics Lab Reminder
Laboratory services provided to our HMO and POS members must be performed by Quest Diagnostics Lab in order to be covered in-network.
Issue 05 - Drug Therapy Guideline Updates
Drug therapy guidelines for Orencia and Travatan-Z have been updated.
Issue 04 - Adjustment Policy Reminder
We want to remind you about our Standard Claim Adjustment Policy.
Issue 03 - Association for Medical Ethics
We are partnering with the Association for Medical Ethics (AME) to encourage the use of evidence-based medicine to improve patient care.
Issue 02 - Radiation Therapy Treatment Notification Transition Cases
A Radiation Therapy Treatment Notification Form for Transition Cases is required for new members (enrolled on or after January 1, 2012) who are currently receiving radiation therapy treatment.
Issue 01 - Level-of-Care Review Update
Effective February 15, 2012, we will begin a two-step review process for elective inpatient hospital procedures.