Provider Bulletins

• Issue 22 - Updates to Our Opioid Management Strategy We want you to be aware of requirements tied to our opioid management strategy.
• Issue 21 - Updated Medicare Advantage Coding Requirements for OB/GYN Providers Effective April 1, 2019, we will no longer reimburse OB/GYN and associated subspecialties for Medicare Advantage (MA) member claims with certain Current Procedural Terminology (CPT) codes.
• Issue 20 - ClaimsXten Clinical Editor and Modifier 59 We have launched our new clinical editor, ClaimsXten.
• Issue 19 - Only 2012 ADA Dental Claim Forms Accepted Effective December 1, 2018, BlueShield of Northeastern New York will no longer accept American Dental Association (ADA) claim forms older than the 2012 version.
• Issue 18 - Reimbursement for Services Related to Medication-Assisted Treatment for Opioid Use Disorders Reimbursement is available for professional services related to the prescription and administration of medication for the treatment of opioid use disorders.
• Issue 17 - Drug Therapy Guidelines Updates Available Online The following drug therapy guidelines have been updated.
• Issue 16 - New Dental Pre-Determination Estimated Benefits Summary We're moving to a clearer, simpler dental pre-determination summary for you and your BlueShield of Northeastern New York patients.
• Issue 15 - 2018 Pediatric Incentive Attestation Form Available Online The attestation form for the 2018 pediatric incentive is now available online.
• Issue 14 - New Specialty Review Process for Elective Surgery Effective October 15, 2018, we're moving to a more efficient preauthorization process for elective surgical procedures.
• Issue 13 - Coding Advisor We're introducing a program to improve coding accuracy.
• Issue 12 - New Process for Palliative Care Services We're starting a simpler process for palliative care services.
• Issue 11 - Genetic Testing for Hereditary Breast Cancer We have expanded and simplified our "Genetic Testing for Hereditary Breast and Ovarian Cancer Syndrome" medical protocol, effective August 1, 2018.
• Issue 10 - 2017 Incentive Payment Your incentive payments have been mailed and summary reports are now available on our secure provider portal.
• Issue 9 - Updated Drug Therapy Guidelines Available Online We have updated the following drug therapy guidelines.
• Issue 8 - ADA 2012 Dental Claim Forms to be Required Effective December 1, 2018, BlueShield of NENY will accept only the 2012 version of the American Dental Association (ADA) dental claim form.
• Issue 7 - Telehealth Reimbursement Available to Behavioral Health Providers We are now reimbursing behavioral health providers for telehealth services.
• Issue 6 - New Clinical Editor ClaimsXten We are replacing our current clinical editor with the enhanced ClaimsXten system.
• Issue 5 - Important Fee Schedule Update Our standard fee schedule and rates will be updated to better align with the market and standards set by CMS, effective July 1, 2018.
• Issue 4 - Updated Drug Therapy Guidelines Available We have updated the drug therapy guidelines.
• Issue 3 - Pediatric Incentive Opportunity We are offering a new pediatric incentive program exclusively for primary care providers.
• Issue 2 – SBIRT to be Reimbursed We've updated our coverage policy to include reimbursement of SBIRT (Screening, Brief Intervention, and Referral to Treatment), effective February 1, 2018. SBIRT was previously considered No Special Fee (NSF).
• Issue 1 – Updated Drug Therapy Guidelines Available Online We have updated the attached drug therapy guidelines.