Clinical Updates, Reminders and Resources |
Use Our New Form for Anti-VEGF Intravitreal Injection Therapy Verification
Blue Cross and Blue Shield of Illinois reviews voluntary requests for recommended clinical review of anti-VEGF (vascular endothelial growth factor) intravitreal injections for certain eye conditions when services are proposed for our commercial non-HMO and Federal Employee Program® members. It’s important to include all necessary information to support your RCR request.
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CMO Perspective Offers Ideas for Patient Discussions on Kidney Health
We invite you to read the latest CMO Perspective post, Chronic Kidney Disease: Help Your Patients Understand Risk Factors and Preventive Measures. In this entry, Dr. Derek Robinson, M.D. shares highlights from a March TV segment on CKD dangers and what patients can do to protect their kidneys.
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Supporting Maternal Quality Care
Prenatal and postpartum care contributes to the long-term well-being of new mothers and their infants, according to the American College of Obstetricians and Gynecologists.
We encourage you to talk with our members about the importance of attending all care visits during and after pregnancy.
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Focus on Behavioral Health |
Requests for Behavioral Health Documentation for Medicaid Members
Behavioral health providers may receive requests from BCBSIL for our Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members’ medical records and supporting documentation. We review documentation for behavioral health records to comply with regulatory standards and to monitor our members’ care.
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Filing Claims for Applied Behavior Analysis Services – Use the Correct Place of Service Code
It’s important that you use the correct Place of Service code when filing professional claims for Applied Behavior Analysis and other services that may be eligible for delivery in multiple locations. POS codes designate where the patient was located when they received services from you.
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Claims and Coding |
Prior Authorization Code Updates for Some Commercial and Government Programs Members, Effective July 1, 2024
BCBSIL is changing prior authorization requirements that may apply to some commercial non-HMO and government programs (Blue Cross Medicare Advantage (PPO)SM, BCCHPSM and MMAI) members. Refer to News and Updates for a summary of commercial and government programs changes and code updates.
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Late and Added Charges Must Be Submitted as a Corrected Claim
Effective July 1, 2024, all late charges must be submitted to BCBSIL as a corrected claim after the original claim has been processed.
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