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BLUE CROSS BLUE SHIELD UPDATES

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Effective March 1, 2018 Venipuncture/Capillary Blood Collection procedures 36415, S9529 and 36416 are eligible for separate reimbursement when reported with an E/M and/or a laboratory service. Unless medical necessity exists, these services are allowed once per member, per provider, per date of service. 

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Medicare Advantage members may be rewarded when they complete their preventive screenings with their PCP. Eligible members will receive a gift card for competing their screening mammogram, a colorectal cancer screening or their diabetes retinal exam.  

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MyDiversePatients.com provides educational resources:

  • CME learning experiences about disparities, potential contributing factors and opportunities for you to enhance care.
  • Real life stories about diverse patients and the unique challenges they face.
  • Tips and techniques for working with diverse patients to promote improvement in health outcomes. 

Visit MyDiversePatients.com today to learn more. 

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Alliant Health Solutions is to assist Empire BCBS in validating provider compliance with applicable reimbursement policies and identify instances of incorrect billing for behavioral health services. If you receive a request for information from Alliant Health Solutions your compliance is required. Alliant findings may result in provider audits and record reviews, education and other direct outreach.  

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Effective November 1, 2018 network fee schedule will be updated. The actual impact to any particular physician will depend on the codes most frequently billed by that physician. The updated fee schedule will be available at www.empireblue.com on November 1, 2018. 

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Provider Transparency Update.

Quality and/or cost information about the health care providers to which the PCPs refer their Attributed Members (the “Referral Providers”) will be available in the Enhanced Personal Health Care (EPHC) Program. If a Referral Provider is higher quality and/or lower cost, this component of the program should result in their getting more referrals from PCPs. The converse should be true if Referral Providers are lower quality and/or higher cost. Also the Cost Opportunity Report is available for EPHC providers to access via Provider Care Management Solutions (PCMS). Empire will share data on which it relied in making these quality/cost evaluations upon request, and will discuss it with Referral Providers including any opportunities for improvement. For questions or support, please refer to your local network representative or Care Consultant. 

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Insights
August 2018