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…

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…

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

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…

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…

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…

Does BCBS follow Medicare guidelines? Yes, BCBS follows Medicare NCCI edits and the same has been incorporated into BCBS editing system. BCBS considers CMS NCCI edits are a recognized industry source for relationships between codes. All BCBS code editing systems will be incorporated with Medicare NCCI edits but the implementation dates differs between the states….

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. •…

Epidural Injections The total number of epidural, subarachnoid, or caudal injections (CPT 62310 and CPT code 62311) are limited to three (3) in six (6) months and are billed in addition to CPT code 77003 (fluoroscopy) or CPT code 72275 (epidurography). Epidural or subarachnoid injections (CPT code 62310, and CPT code 62311) are limited to…