May 2024 Blue Review

BlueCross BlueShield of Illinois
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Blue Review

For Providers

May 2024


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.

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.

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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Avoid National Drug Code Billing Errors

Submitting claims with the appropriate NDC information is important for claims processing and may help you spend less time troubleshooting a rejected claim line.

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Coding Webinars: Arrhythmias and Rheumatoid Arthritis 

Join our Coding Compliance team for two webinars on coding and guidelines.
These trainings are free to providers and coding professionals.

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Pharmacy Program

Pharmacy Program Updates: Prior Authorization Changes Effective June 1 and June 15, 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 June 1 and June 15.

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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Community Involvement

BCCHP 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 May 16, 2024. Read more on News and Updates.

Notification and Disclosure

Has your information changed? Let us know!

When seeking health care services, our members often rely upon the information in our online Provider Finder®. Prospective patients can use this online tool to confirm if your practice is a contracted in-network provider for their health care benefit plan.

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Stay informed!
Watch News and Updates on our Provider website for important announcements.

Verify and Update Your Information
Verify your directory information every 90 days. Use the Availity® Essentials Provider Data Management feature or our Demographic Change Form. Facilities may only use the Demographic Change Form.

Provider Training
For dates, times and online registration, visit the Webinars and Workshops page.

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