Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims

Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims

Outpatient Laboratory Claims: Referring Practitioner Required In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers. Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical…

New Reimbursement Guidelines for Smoking Cessation

Effective September 26, 2019, Horizon BCBSNJ will change the way consider certain professional claims for smoking cessation services provided September 26, 2019. In accordance with CMS guidelines, Horizon BCBSNJ shall consider for reimbursement smoking and tobacco cessation counseling visits (99406 or 99407) for asymptomatic patients when billed with an approved diagnosis code. Approved Diagnosis Codes: Nicotine dependence (F17.21-F17.299)…

Changes in Allergy Testing Guidelines

Changes in Allergy Testing Guidelines

Effective September 10, 2019, Horizon BCBSN will change the way consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) members based on an update to our medical policy, Allergy Testing. Based on the submitted diagnosis code(s), claims submitted for services provided on and after September 10, 2019 to patients enrolled in Horizon BCBSNJ…

BCBS Reimbursement Policy Update: Bundled Services-Professional

BCBS Reimbursement Policy Update: Bundled Services-Professional

Beginning with dates of service on or after November 1, 2019, new Inter-professional CPT codes 99451 and 99452 are not eligible for reimbursement when they are reported with another service or reported as a stand-alone service.  These codes have been added to policy section 1 of the Bundled Services and Supplies reimbursement policy. Source: https://providernews.anthem.com/indiana/article/reimbursement-policy-update-bundled-services-professional

Florida Blue – Type 2 NPI is Required for Providers Billing with EIN

Florida Blue – Type 2 NPI is Required for Providers Billing with EIN

For individual providers who submit electronic claims with their Employee Identification Number (EIN) rather than their Social Security Number (SSN), a new policy from Florida Blue applies immediately. The policy, which strengthens alignment with the Centers for Medicare & Medicaid Services (CMS), requires such providers to have a valid Type 2 National Provider Identification (NPI…

Florida Blue follows Medicare edits for Multiple Diagnostic Procedures

Florida Blue follows Medicare edits for Multiple Diagnostic Procedures

Effective for the date of services from August 1, 2014, Florida Blue will implement a new coding edit that affects payment for multiple diagnostic cardiology procedures performed on the same day by the same provider group. Claims processed for dates of service August 1, 2014 and after will process according to the new rule.  When multiple…

BCBS Florida After Hours and Weekend Care Payment Policy CPT codes 99050, 99051, 99053, 99056, 99058 and 99060

BCBS Florida After Hours and Weekend Care Payment Policy CPT codes 99050, 99051, 99053, 99056, 99058 and 99060

Effective April 13, 2012, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) will no longer reimburse separately for the Current Procedural Terminology CPT 99051. These services, including basic services, are provided during regularly scheduled evening, weekend, and holiday office hours. Reimbursement for the primary service provided, such as the office visit, will continue to…

BCBS Reimbursement for Well Child Care – Coverage Frequency and Limitations

BCBS Reimbursement for Well Child Care – Coverage Frequency and Limitations

Well-child care refers to physician-provided preventive health care services for children. The well-child benefit applies to an insured dependent child under Blue Cross and Blue Shield of Florida BlueOptions, BlueChoice or Traditional products. Well-child services include: • The first newborn examination in the hospital by a physician other than the delivering obstetrician or anesthesiologist. •…