December 2021

Wellness and Member Education

Free Flu and SAD Programs at Blue Door Neighborhood Center^SM

Our Blue Door Neighborhood Center (BDNC^SM) locations will be offering free in-person and virtual National Influenza (flu) Vaccination Week and Seasonal Affective Disorder (SAD) Awareness Month events in December.

Network Innovation/Product Updates

New Flexible Medicare Advantage PPO Plan

We’re offering certain Blue Cross Medicare Advantage^SM members a new way to access care. The Blue Cross Medicare Advantage Flex (PPO)^SM Plan is an open access plan.

Electronic Options

Single Sign-On Access to AIM Specialty Health^® via Availity^®

Checking patient eligibility and benefits via Availity or your preferred web vendor is an imperative first step to confirm coverage and prior authorization requirements before rendering services for Blue Cross and Blue Shield of Illinois (BCBSIL) members. If prior authorization through AIM is required for a requested service, you can access AIM via the new single sign-on feature on Availity.

View Withdrawn Claim Descriptions via the Availity Claim Status Tool

There may be instances when you receive a “claim withdrawn” notification by mail after submission of a claim to BCBSIL. You may also determine why a claim was withdrawn via the Availity Claim Status tool response.

Clinical Updates, Resources and Reminders

Prior Authorization Reform Act (Applies to Fully Insured Non-HMO and Illinois Medicaid Plans Only)

The Prior Authorization Reform Act (House Bill 711) was signed into Illinois law on Aug. 19, 2021. The new law takes effect as of Jan. 1, 2022. BCBSIL is making necessary changes for adherence with Illinois state-mandated requirements. These changes will only affect the prior authorization review process for services for our fully insured non-HMO members, including Illinois Medicaid.

New Laboratory Policies and Claim Simulation Tool Coming Jan. 1, 2022: Join Us for A Webinar to Prepare

Effective Jan. 1, 2022, BCBSIL will implement new policies and a new program for claims for certain outpatient laboratory services provided to our fully insured commercial non-HMO members. We encourage you to attend a December webinar to learn more, such as how to use the program’s Trial Claim Advice Tool to input codes and diagnoses and see the potential outcome, before submitting a claim. For webinar dates and registration links, see the News and Updates.

Commercial Prior Authorization: Code Updates Effective Jan. 1, 2022; Cardiology (Echo) Webinars in December

BCBSIL is changing prior authorization requirements that may apply to some commercial non-HMO members. We’ve posted a summary of codes being removed effective Jan. 1, 2022, with a reminder of codes being added for Cardiology (Echo) services. There are three targeted training sessions this month on how to submit Cardiology (Echo) prior authorization requests. Read more in News and Updates.

Claims and Coding

Watch for a Letter on Fighting Fraud, Waste and Abuse

Every year, analysts and investigators for BCBSIL review claims data, industry trends and investigative results to identify potential areas of fraud and waste. 

COVID-19 Vaccine Billing for Medicare Advantage and MMAI Members

Starting Jan. 1, 2022, BCBSIL will cover the cost of COVID-19 vaccines and their administration for Blue Cross Medicare Advantage HMO^SM (MA HMO), Blue Cross Medicare Advantage PPO^SM (MA PPO) and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM members instead of the Original Medicare program (also known as fee-for-service Medicare). Read more in News and Updates.

Preventive and Follow-Up Colonoscopies, Changes Effective Jan. 1, 2022

As of Jan. 1, 2022, in compliance with Illinois House Bill 2653, follow-up colonoscopies billed with applicable American Medical Association (AMA) diagnosis codes will be processed according to the appropriate preventive and follow-up benefits for commercial fully insured BCBSIL members. Accurate claim coding is essential to receiving correct payment for a preventive care service, such as an initial diagnostic colonoscopy, or a follow-up colonoscopy if the results of the initial colonoscopy, test or procedure are abnormal. 

Updated 2022 Telehealth Services

In 2022, BCBSIL will continue to provide benefits for the expanded telehealth services similar to our 2021 coverage and consistent with guidelines from the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS). We will continue to accept telehealth claims from both professionals and facilities and adjudicate them in accordance with each member’s benefits. Read more in News and Updates.

Provider Education

BCBSIL Will Be Contacting Providers Soon for Telehealth Information

BCBSIL will soon begin contacting providers to inquire whether telehealth services are available at their practice. In accordance with Senate Bill 332, which amends the Network Adequacy and Transparency Act, BCBSIL will update our printed directory and our online provider directory, Provider Finder^®, with this information.

Payment Recovery Program Reminders

As part of our Payment Recovery Program, BCBSIL may recoup overpayments made to BCBSIL contracted facilities and professional providers in the PPO, Blue Choice PPO^SM, Blue High Performance Network^SM (BlueHPN^SM) and any of our commercial HMO product networks when payment errors have occurred. Overpayments may be identified by BCBSIL and/or the provider.

Network Operations Update: Voicemail and Email Deactivation, Answers to Commonly Asked Questions

In an effort to streamline provider inquiries and improve administrative processes, the BCBSIL Network Operations team is retiring the following phone number/voicemail and email address: 312-653-6555, NetOps_provider_update@bcbsil.com.

Provider Learning Opportunities

BCBSIL offers free webinars and workshops for the independently contracted providers who work with us. A preview of upcoming training sessions is included in this month’s issue.

Pharmacy Program

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 1

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions, revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) were made to the BCBSIL drug lists. Changes effective on or after Jan. 1, 2022, are outlined here.

Quality Improvement and Reporting

Hospital Discharge Summaries Contain Important Information for Primary Care Providers

It’s important for primary care providers (PCPs) to know details about the care their patients receive during inpatient hospital stays.

Recommendations and Reminders for Eye Care Professionals

Many PCPs refer our diabetic Federal Employee Program^® (FEP^®) members to eye care specialists for annual eye examinations. We encourage eye care specialists to promptly communicate exam results to the PCP to help coordinate the member’s care.

2021 Reminder to Encourage Early and Timely Intervention for Pre- and Post-natal Care

This article includes important information to help you when providing pre- and post-natal care and services to FEP members.

Notification and Disclosure

Member Rights and Responsibilities

As a participating provider, it’s important that you are aware of our members’ rights and responsibilities.

Provider Rights and Responsibilities

As a participating provider in BCBSIL provider networks, you have certain rights and responsibilities. We publish this information for providers annually.

Medical Policy Updates

Approved, new or revised BCBSIL Medical Policies and their effective dates are usually posted on our Provider website the first day of each month.

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