Blue Review - March 2021 | view in Web Browser
A newsletter for contracting institutional and professional providers |
March 2021
Wellness and Member Education
Free Minority Health Programs Next Month at Blue Door Neighborhood CenterSM
Encourage your patients to check out the free National Minority Health Month events hosted by our Blue Door Neighborhood Center (BDNCSM). Since programming is virtual due to COVID-19, all your patients can take advantage of these activities no matter where they live.
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Clinical Updates, Resources and Reminders
Telehealth Services for Our Government Programs Members
This article includes general information on telehealth services during the COVID-19 Public Health Emergency (PHE) to help with claims coding and documentation for our government programs members.
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Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Appointment Availability Timeframes
To ensure that BCCHP and MMAI members have timely access to care, the following appointment standards are specified in your provider agreements.
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Medicaid Providers: Updated Prior Authorization Tips and Peer-to-Peer Discussion Process (One Change Effective May 1, 2021)
Blue Cross and Blue Shield of Illinois (BCBSIL) would like to outline some important updates, tips and reminders on prior authorization processes for independently contracted providers treating our BCCHP and MMAI members.
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Electronic Options
Check Eligibility and Benefits: Don’t skip this important first step!
Is your patient’s membership with BCBSIL still active? Are you or your practice/medical group in- or out-of-network for a specific patient? Is prior authorization required for a particular member/service?
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Provider Education
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.
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Overpayment Recovery for Multiple Surgical Procedures
On June 1, 2021, BCBSIL will begin additional reviews of claims after payment to make sure they adhere to our reimbursement policy for multiple surgical procedures.
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What’s New
DME Benefit Limits Verification Request Form
As of Feb. 1, 2021, if you provide Durable Medical Equipment (DME) services to our BCCHP and/or MMAI members, you may use our new DME Benefit Limits Verification Request Form.
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Pharmacy Program
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 – 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 April 1, 2021, are outlined here.
Claims and Coding
CPT® Category II Codes Can Help Close Care Gaps
Using the proper Current Procedural Terminology (CPT) Category II codes when filing claims may help you streamline your administrative processes and close gaps in care.
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Health Care Fraud is Not a Victimless Crime
Most health care fraud in the U.S. is committed by a small minority of health care providers and/or organized crime syndicates posing as legitimate health care professionals. At BCBSIL, we actively participate in inquiries and investigations to accurately identify and appropriately address potentially fraudulent activities.
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Notification and Disclosure
Important Dates and Reminders
Check here each month for a quick snapshot of recent implementations, upcoming changes, special events, important deadlines and other reminders.
Procedure Code and Fee Schedule Updates
As part of our commitment to informing our independently contracted providers of certain developments, BCBSIL has designated a specific section in the Blue Review to notify you of any significant changes to the physician fee schedules.
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ClaimsXtenTM Quarterly Updates
New and revised CPT and Healthcare Common Procedure Coding System (HCPCS) codes are periodically added to, or deleted from, the ClaimsXten code auditing tool software by the software vendor on a quarterly basis and aren’t considered changes to the software version.
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Stay informed! Watch the News and Updates on our Provider website for important announcements. Update Your Information Do you need to update your location, phone number, email or other important details on file with BCBSIL? Use our online forms to request an information change. Provider Training For dates, times and online registration, visit the Webinars and Workshops page. |
Quick Reminders
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Contact UsBlue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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