Volume 20, 2014

Issue 40 - 2015 Fee Schedule Announced
We want to let you know that BlueCross BlueShield of Western New York will issue updated Standard Commercial and Medicare Advantage Fee Schedules effective January 1, 2015. Further updates will be made to the fee schedules on April 1, 2015.
Issue 39 – Post-Operative Nerve Blocks for Pain Management
We want to keep you informed about postoperative pain management reimbursement guidelines.
Issue 38 – Your Contact Information Needed
We need your most up-to-date information for our provider directories and online provider search tool.
Issue 37 – Pay for Performance 2014 Program Update
We want to let you know that you have the opportunity to submit medical records for quality compliance as a participant in our Pay for Performance (P4P) program.
Issue 36 – Adjustment Policy Update
We want to let you know that, effective immediately, Federal Employee Program (FEP) claims with an "R" prefix are no longer excluded from our Standard Claim Adjustment Policy, which was implemented January 1, 2005.
Issue 35 – Important Notification Regarding Incentive Plans
We want to let you know about upcoming changes to our Pay for Performance (P4P) and patient-centered medical home (PCMH) programs.
Issue 34 – Drug Therapy Guideline Updates Available on our Website
We want to let you know about new drug therapy guidelines that take effect January 1, 2015.
Issue 33 – Cardiac Catheterization Preauthorization No Longer Required
We want to let you know that the preauthorization requirement for cardiac catheterization is being removed.
Issue 32 – 2014 Provider Satisfaction Survey Available On Our Website
We’d like to know how we can serve you better.
Issue 31 – Clarification of Changes to Senior Blue HMO
We want to clarify changes to our Senior Blue HMO Select Medicare Advantage product and how they may affect your patients.
Issue 30 – Updates to Drug Therapy Guidelines Pertaining to Chronic Hepatitis C
On December 1, 2014, our corporate Drug Therapy Guidelines regarding medications that treat chronic Hepatitis C will be updated.
Issue 29 – Paperless Notification Available from NIA
Beginning November 1, 2014, National Imaging Associates (NIA) will offer electronic notifications for advanced imaging requests placed at RadMD.com.
Issue 28 – Pay for Performance 2014 Program Update
Effective October 1, 2014, you now have the opportunity to submit medical records for quality compliance with the Pay for Performance (P4P) program.
Issue 27 – New Medicare Advantage Products Announced
We want to let you know about our two new Medicare Advantage products.
Issue 26 - Medicare Advantage Direct Pay Changes
We want to let you know about a series of changes to our Medicare Advantage direct pay products.
Issue 25 - Medical Injectables Reimbursement Changes and Preferred Provider for Synagis
Effective January 1, 2015, our corporate medical injectable fee schedule for Synagis®, IVIG therapy, Fusilev™, and hemophilia factor products will change. Effective immediately, Walgreens will be our preferred provider for Synagis.
Issue 24 - Reimbursement Clarification
We have discovered that our system may not have correctly processed certain claims for your facility.
Issue 23 - Identification Card Update
We want to let you know about a minor change in the look and feel of our member identification (ID) cards.
Issue 22 - 2015 Fee Schedule Update for Durable Medical Equipment
Effective January 1, 2015, our Commercial and Medicare Advantage fee schedules for Durable Medical Equipment (DME) and Orthotic and Prosthetic (O & P) will be updated.
Issue 21 - PCMH Update
We have revised our notification process regarding changes in National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition status.
Issue 20 - Drug Therapy Guideline Updates Available on our Website
The updated guidelines will be effective September 15, 2014.
Issue 19 - New Contractor for CMS Quality Improvement Organization Program
We want to let you know that—effective August 1, 2014—the new contractor for the CMS Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) program is Livanta (replacing the QIO contractor, IPRO).
Issue 18 - Cosmetic Service Fee Schedule Changes
Effective November 1, 2014, our corporate fee schedule for chemical peel procedures will change.
Issue 17 - Pay for Performance Update
The McKesson Risk Manager™ (MRM) analytics tool has been fully implemented and we are ready to present the components of our 2014 Pay for Performance (P4P) program.
Issue 16 - Fraud, Waste, and Abuse Reminder
Your contract with BlueCross BlueShield of Western New York requires you to comply with specific policies to detect and prevent fraud, waste, and abuse.
Issue 15 - Walgreens Specialty Pharmacy
We want to let you know that—effective September 1, 2014—we are transitioning from Accredo Specialty pharmacy to Walgreens Specialty Pharmacy.
Issue 14 - Low-dose CT Screening at Roswell Park
The United States Preventive Services Task Force (USPSTF) recently published recommendations for screening for lung cancer with low-dose computed tomography (CT).
Issue 13 - Actemra and Orencia IV Coverage Criteria
Effective August 1, 2014, criteria for coverage under the medical benefit for Actemra and Orencia IV to treat rheumatoid arthritis will change.
Issue 12 - Pay for Performace Update
This is an update about your Pay for Performance Program (P4P) and/or Community Behavioral Health Outpatient Quality Metric incentive payment.
Issue 11 - Reimbursement Clarification
We have discovered that our system may not have processed claims using the ‘lesser of’ methodology for your skilled nursing facility.
Issue 10 - Pay for Performance Update
Performance Summaries for your recent 2012 Pay for Performance Program (P4P) and/or Community Behavioral Health Outpatient Quality Metric incentive payment are now available.
Issue 9 - Drug Therapy Guideline Updates Available on our Website
The updated guidelines will be effective June 15, 2014.
Issue 8 - Reimbursement Changes for Sleep Studies
Effective July 15, 2014, we will change our fee schedule for lab-based and home-based sleep studies for patients with the suspected diagnosis of obstructive sleep apnea (OSA).
Issue 7 - HIPPS Codes Required for Home Health Care and Skilled Nursing Facility Claim Submissions
The Centers for Medicare & Medicaid Services (CMS) has mandated that Health Insurance Prospective Payment System (HIPPS) coding is to be used for all Medicare Advantage home health care and skilled nursing claims.
Issue 6 - Medicaid Managed Care Update
This is an update regarding the Medicaid Fee Schedule and the status of the Primary Care Rate Increase (PCRI).
Issue 5 - Medical Injectables Reimbursement Changes
Effective July 1, 2014, our corporate medical injectable fee schedule will change.
Issue 4 - Pay for Performance Update
Primary care physicians have participated in our Pay for Performance program since 2002.
Issue 3 - Drug Therapy Guideline Updates Available on our Website
Updated guidelines will be effective March 15, 2014.
Issue 2 - Digital Breast Tomosynthesis Coverage Update
We have updated our coverage policy for Digital Breast Tomosynthesis (DBT) referenced in our Stat Bulletin of December 20, 2013.
Issue 1 - Radiation Oncology Preauthorization Update
We are modifying our radiation oncology program through National Imaging Associates (NIA) effective March 1, 2014.