Has Your Information Changed? Update Us and the NPI Registry

Our members rely on accurate provider information to find care. When your practice address, phone number or other demographic information changes, please update us.

Check Eligibility and Benefits: Don’t Skip This Important First Step

Is your patient’s membership with us still active? Are you or your practice/medical group in-network or out-of-network for a specific patient? Is prior authorization required for a particular member/service?

Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units

Incorrect coding on claims for Transcutaneous Electrical Nerve Stimulation Units and necessary supplies causes additional costs for you and our members. This article covers tips to help ensure proper billing for medically necessary care and services.

Check Prior Authorization Requirements for Procedure Codes Through Availity^® Essentials or Our Automated Phone System

You can check prior authorization requirements for procedure codes online by using Availity Essentials Eligibility and Benefits. If you aren’t able to check online, our interactive voice phone system has a new menu option to quickly confirm this information for our commercial members.

Prior Authorization Code Updates for Some Commercial and Government Programs Members, Effective Oct. 1, 2024

We’re changing prior authorization requirements that may apply to some commercial non-HMO and government programs [Blue Cross Medicare Advantage (PPO)^SM, Blue Cross Community Health Plans^SM and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM] members. Refer to News and Updates for a summary of commercial and government programs changes and code updates. 

BCCHP^SM and MMAI Providers: Join Our Community Stakeholder Committee

We’re hosting quarterly Community Stakeholder Committee meetings to find ways to better serve our BCCHP and MMAI members. We’d like to invite you to join us for our next committee meeting on Aug. 15, 2024. Read more on News and Updates.

Cultural Awareness Webinars: No-Cost Continuing Education Credit

We offer a suite of no-cost webinars that provide cultural awareness training and continuing education credit.

Provider Learning Opportunities

We offer 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.

Medicare Providers May Treat Blue Cross Group Medicare Advantage Open Access (PPO)^SM Members

If you’re a Medicare provider, you may treat Blue Cross Group Medicare Advantage Open Access (PPO) members. This is an open access, non-differential national PPO plan without network restrictions.

Notify Us if You Opt Out of Medicare

Blue Cross Medicare Advantage^SM plan and MMAI providers who choose to opt out of Medicare should immediately notify their Provider Network Consultant.

Pharmacy Program Updates: Prior Authorization Changes Effective July 1 and Oct. 1, 2024

The pharmacy PA program encourages safe, cost-effective medication use by allowing coverage when certain conditions are met. A clinical team of physicians and pharmacists develops and approves the clinical programs and criteria for medications that are appropriate for PA by reviewing U.S. FDA-approved labeling, scientific literature and nationally recognized guidelines. Read more on News and Updates for changes effective July 1 and Oct. 1.

Physician Performance Insights Reports Coming Soon from PEAQ^SM

In September, physicians eligible for our Physician Efficiency, Appropriateness, & Quality^SM program can view their Physician Performance Insights reports. PPI reports show how physicians compare to their peers and include information on improving performance.

Provider Finder^® to Rank Providers To Help PPO Members Find Care

Later this year, Provider Finder will add a tiering feature that shows how providers rank against peers in their working specialties for some PPO products. The tier will display only for members in employer groups with a tiered benefit option.

Encourage Routine Vaccines and Well-Care Visits for Children and Teens

Many children and adolescents are still catching up on missed routine immunizations and well-care visits, according to the Centers for Disease Control and Prevention. The CDC recommends that doctors and health care professionals encourage families to schedule vaccines and visits for their children.