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BCBSGA Medicare Advantage Plan & Administrative Changes/Updates

PW_A122614

Posting Date 
Subject 
Document 
08/23/2016 
Prior Authorization Requirements for Inflectra and Cinqair 
 
08/18/2016 
Hospital Observation Service Limits 
 
08/13/2016 
Prior Authorization Requirements for new Injectable/Infusible Drugs: Darzalex and Empliciti 
 
08/12/2016 
Prior Authorization Requirements for new Injectable/Infusible Drugs: Istodax, Ixempra, and Taltz 
 
08/01/2016 
Home Health Billing Instructions 
 
08/01/2016 
Please Use Medicare Billing Guidelines when filing Preventive Services Claims 
 
08/01/2016 
Claim Adjustments May Change Member Cost Share 
 
08/01/2016 
Ensure the Accuracy of Your Information in the Provider Directory 
 
08/01/2016 
Complying with Medical Record Documentation Requests 
 
08/01/2016 
Check Your Contract Prior to Rendering Supplemental Benefits 
 
08/01/2016 
Improve Member’s Medication Adherence with 90-Day Prescriptions 
 
08/01/2016 
Alendronate added to the $0 Copay Tier 
 
08/01/2016 
In-Home Bone Mineral Density Testing 
 
08/01/2016 
Assisting Members with Rheumatoid Arthritis Who May Be Missing Important Medications 
 
08/01/2016 
Clinical Cumulative Morphine Equivalent Dosing Point of Sale Edit effective January 1, 2017 
 
07/28/2016 
NaviHealth Coordinating Prior Authorizations for Highmark Members 
 
07/27/2016 
Complete Your Medicare Advantage AIM OptiNet Registration for X-ray, Ultrasound or High-Tech Imaging Services 
 
07/26/2016 
Care Program Available for Individual Members Facing Advanced Illness 
 
07/25/2016 
Enhancements to AIM Clinical Appropriateness Guidelines for Advanced Imaging effective November 1, 2016 
 
07/20/2016 
Prior Authorization for Emend (Fosaprepitant), Aloxi (Palonosetron), and Afstyla (Antihemophilic) 
 
07/14/2016 
Prior Authorization Requirements for Vascular Embolization or Occlusion Services 
 
07/11/2016 
Reach a Nurse Directly for Prior Authorizations that Require Clinical Reviews 
 
06/30/2016 
Routine Cervical Cancer Screenings 
 
06/15/2016 
June Reimbursement Policy Provider Bulletin 
 
06/15/2016 
ClaimsCheck Upgrade to ClaimXten effective November 1, 2016 
 
05/30/2016 
AIM OptiNet Imaging Services Initiative Postponed 
 
05/06/2016 
Part D Drugs must be Prescribed for FDA-Supported Indications, Medicare Compendiums 
 
05/02/2016 
Reimbursement Policy Provider Bulletin 
 
04/27/2016 
Outpatient Part B Nursing and Long-Term-Care Facilities: Contact OrthoNet for OT and PT Prior Authorizations 
 
04/27/2016 
Contact Medicare Part B Specialty Pharmacy before Injections, Infusion Drug Prior Authorization Expire 
 
04/20/2016 
Inpatient Stays and Observation – Please Help Members Maximize Health Benefits 
 
04/20/2016 
Precertification Requirements Updated for 2016 
 
04/19/2016 
Required Billing Updates for Rural Health Clinics: HCPCS Codes Required for all RHC Claims  
 
03/30/2016 
UPDATED: Skilled Nursing Facilities, Home Health and Long-term Care Facilities: OrthoNet OT and PT Prior Authorization Delayed until Further Notice  
 
03/30/2016 
AIM to Conduct Medical Necessity Reviews for Vascular Ultrasound Procedures  
 
03/30/2016 
Quality Programs Support Patient Safety, Health Improvement  
 
03/30/2016 
AIM to Review Oncology and Oncology Supportive Specialty Drugs for Medical Necessity  
 
03/22/2016 
DSNP Training Required  
 
03/21/2016 
Reminder to include the “Rendering Provider Location” for Radiology Services 
 
03/11/2016 
Quarterly Update to the Medicare Physician Fee Schedule  
 
03/04/2016 
Additional Radiation Oncology Prior Authorizations Should Be Directed to AIM Effective July 1, 2016  
 
02/26/2016 
HealthMap Solutions Gathering Diabetes Screening Results  
 
02/23/2016 
UPDATED: Imaging Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement  
 
02/17/2016 
CMS Required CLIA Certification Number for Labs 
 
02/16/2016 
New Prior Authorization Requirements Effective May 1, 2016 
 
02/02/2016 
Enhanced Reimbursement for Select Medicare Part B Injectables, Avastin will be Applied Retroactively 
 
01/27/2016 
HIPPS Codes Required for SNF and HHA Claims 
 
01/27/2016 
Additional Support Available for Individual Members with Rare Conditions 
 
01/27/2016 
Medicare Notices and Provider Requirements 
 
01/27/2016 
Contact OrthoNet for OT and PT Precertifications in SNF, HH, and LTC 
 
01/27/2016 
Please Review Rx Changes to Help Members Find the Best Medication Values 
 
01/27/2016 
Accurate Information about Your Practice 
 
01/06/2016 
Webinar for all Imaging Providers  
 
12/29/2015 
DME Amendment FAQs 
 
11/30/2015 
Prior Authorization Required for Boniva Starting March 1, 2016 
 
11/30/2015 
More $0 Copay Medication Available to Members with Chronic Conditions 
 
11/25/2015 
Avastin for Ophthalmic Use 
 
11/25/2015 
Enhanced Reimbursement for Select Part B Injectable Drugs 
 
11/20/2015 
Oxygen DME Prior Authorizations to be Reduced in 2016 
 
11/16/2015 
Individual Plans Name Changing for 2016 
 
11/09/2015 
ICD-10-CM Educational Material Now Available on Provider Website 
 
11/09/2015 
Avoid Denials of Diagnostic Claims by Completing Item 20 (CMS 1500) Correctly 
 
11/06/2015 
Include Modifiers to Help Ensure Accurate Payment 
 
11/03/2015 
Providers Must Enroll with Medicare to be able to Prescribe Part D Beginning February 1, 2017 
 
11/03/2015 
Introducing Togetherworks 
 
10/23/2015 
BCBSGA Encourages High-Risk Members to get a Flu Shot 
 
10/15/2015 
Quality Improvement Program 
 
10/03/2015 
Routine Physical Exams Are Covered in 2016 
 
10/03/2015 
2016 Diabetic Supply Coverage Changes for our Individual Medicare Advantage Members 
 
10/01/2015 
Durable Medical Equipment Policy and Ancillary Fee Schedule Updated 
 
10/01/2015 
2016 Medicare Advantage Plan Changes 
 
09/23/2015 
Part B Updates for Praluent, Repatha, and Sylvant 
 
09/23/2015 
ER Level 5 Professional Claim Review 
 
09/18/2015 
Recovery Look-Back Period to Align with CMS 
 
09/18/2015 
New 2016 Prior Authorization Requirements Effective January 1, 2016 
 
09/16/2015 
Imaging Site Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement 
 
09/16/2015 
ICD-10-CM Provider Training 
 
09/09/2015 
Public Provider Portal Navigation and Site Guide 
 
08/28/2015 
Precertification Change for Scoliosis/Spine Deformity 
 
07/13/2015 
Code Editing Enhancements Effective July 18, 2015 for Medicare Advantage Group-Sponsored Claims 
 
07/09/2015 
2015 Retrospective Medical Record Review Program 
 
07/01/2015 
Participating Providers: Bill Medicare Part D for Shingles or Tetanus Vaccination Claims 
 
07/01/2015 
Post Service Drug Claim Edits Updated 
 
06/25/2015 
Provider DSNP Training – July 9th and 23rd 2015 
 
06/25/2015 
Precertification Required on Part B New Injectables 
 
06/25/2015 
Allergy Treatment: Immunotherapy Policy Update 
 
06/05/2015 
Discontinuation of Paper Remits to all ERA Registered Providers Effective October 1, 2015 
 
05/27/2015 
Precertification Required for Part B Drugs 
 
04/20/2015 
House Call Program 
 
04/20/2015 
Facilities: MA Precertification Requirements for Admissions 
 
04/10/2015 
Please Follow CMS Guidelines for Medicare Advantage Part B Immunization Claims Filing 
 
04/07/2015 
Precertification Required for Hemophilia Drugs 
 
03/23/2015 
Medicare Advantage System Migration FAQ 
 
03/16/2015 
Precertification Requests and Information Available Through Availity 
 
03/13/2015 
Dual Eligible Special Needs Plans New for 2015 
 
03/13/2015 
Intensive Outpatient Program Services 
 
03/10/2015 
Transplant and Pretransplant Service Request Instructions for Transplant Service Centers 
 
02/28/2015 
OrthoNet to Conduct Post-Service Prepay Medical Necessity for Select Cardiac Procedures 
 
02/25/2015 
Encouraging Medicare Advantage Members to Stay Up-to-Date on Preventative Care 
 
02/20/2015 
Update to Pneumococcal Vaccine Policy 
 
02/20/2015 
ClaimCheck Version 55 Upgraded Effective April 1, 2015 
 
02/17/2015 
Precertification Required on Four New Part B Injectables 
 
02/16/2015 
Clinical HEDIS Medicare Stars Quick Reference Guide 
 
01/30/2015 
Immune Globulin Home Infusion Therapy Part B Coverage Reminder 
 
01/23/2015 
Flu Season Update 
 
01/17/2015 
Member Identification Prefixes Updated for 2015 
 
01/15/2015 
HMO Referral Reminder- PCPs Do Not Need to Call BCBSGA to Obtain a Referral 
 
01/15/2015 
Reminder: Clinical Information Required for Medicare Advantage Members 
 
12/31/2014 
Medicare Advantage Reimbursement Policy Changes: Second Communication Update 
 
12/24/2014 
EGR Member Directories Notification 
 
12/24/2014 
Clearing House Helps Ensure Timely and Accurate Claims Payment for Vaccines Covered by Medicare Part D 
 
12/24/2014 
Dual Eligible Special Needs Plan Provider Training 
 
12/18/2014 
New 2015 Fax Number for Skilled Nursing, Long Term Acute Care, and Inpatient Rehabilitation 
 
12/15/2014 
Skilled Nursing Facility – Continued Stay Request 
 
12/09/2014 
Flu Prevention and Treatment Saves Lives 
 
12/09/2014 
Provider Requirements and Medicare Notices 
 
12/09/2014 
National Coverage Determinations 
 
11/26/2014 
Ancillary Claims Filing Requirements – Important Reminder 
 
11/21/2014 
2015 Georgia Medicare Advantage Plan Changes 
 
11/01/2014 
OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews 
 
10/30/2014 
Capped DME Rentals 
 
10/21/2014 
Flu Vaccinations 
 
10/18/2014 
Prior Authorization Required for Members 
 
10/16/2014 
GN-GO-GP Required on Therapy Claims 
 
10/03/2014 
Hydrocodone Combination Products Moving to Schedule II 
 
10/03/2014 
Encourage Exercise to Prevent Falls 
 
10/03/2014 
Inpatient Readmissions 
 
10/03/2014 
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare 
 
10/01/2014 
Peer to Peer Process 
 
10/01/2014 
2015 Coverage Changes for Diabetic Supplies For Our Individual Medicare Advantage Members 
 
09/18/2014 
Changing 2015 Individual Plans Service Areas 
 
08/26/2014 
System Migration Overview 
 
08/21/2014 
Reimbursement Policy Changes 
 
07/24/2014 
Natural Disaster Updates (Dec 2012 – Aug 2013) 
 
07/24/2014 
Billing Clarification for Bevacizumab 
 
07/01/2014 
Chemo Assays Test Billing 
 
06/25/2014 
Cancer Care Quality Program Requires Certain Rx Precertifications 
 
06/20/2014 
HIPPS Codes Required for All Skilled Nursing and Home Health Providers 
 
06/03/2014 
Routine Physicals Covered in 2014 
 
05/07/2014 
Precertification of Cardiac Catheterizations 
 
04/25/2014 
Helping Our Members Schedule Office Visits/Preventive Screenings 
 
04/24/2014 
July 2014 Changes to Precertification 
 
03/28/2014 
Non-Contracting Providers may NOT Balance Bill or Bill the Member Directly 
 
03/28/2014 
Negative Formulary Update 
 
03/20/2014 
CPAP / BiPAP Devices and Related Supplies 
 
03/14/2014 
2014 House Call Program 
 
03/11/2014 
Private Rooms 
 
02/21/2014 
Update CMS 1500 Claim Form 
 
01/31/2014 
Ordering/Referring NPI Requirements 
 
01/28/2014 
Encounter Data 
 
12/31/2013 
Hospice Election Lookup Tool on CMS 
 
12/30/2013 
2014 DME Diabetic Supply Changes 
 
12/24/2013 
Medicare Advantage Changes in 2014 
 
12/23/2013 
State of Georgia Medicare Advantage Plan 
 
11/21/2013 
Self-Administered Drugs 
 
11/11/2013 
Natural Disaster Information for AL, FL, LA, and PA 
 
11/01/2013 
BlueCross BlueShield of GA 2014 Medicare Advantage Updates 
 
10/22/2013 
2013 Medicare Advantage Healthy Checklist  
 
10/18/2013 
Medicare Advantage Provider Site Guide  
 
10/09/2013 
Update: Avoidable Readmissions May Lead to Administrative Claim Denials 
 
10/08/2013 
Natural disaster Information for AR, CO, and MO  
 
10/08/2013 
Acupuncture and Chiropractic Benefits Not Offered in 2014  
 
10/01/2013 
2014 Insulin Coverage Changes  
 
10/01/2013 
Natural Disaster Information for CA, FL, NH, and TX 
 
09/18/2013 
Natural Disaster Updates for IA, NY, ND, SD, VT, and WI  
 
09/17/2013 
2014 Diabetic Supply Coverage Changes 
 
08/19/2013 
Chemo Assays Test Billing 
 
08/14/2013 
Member Submitted Claims 
 
08/07/2013 
Coverage of Wigs 
 
08/07/2013 
Natural Disaster Information for CO, IA, ND, and VT 
 
07/30/2013 
October 2013 Change to Ambulance Fee Schedule 
 
07/15/2013 
2013 National Uniform Billing Committee UB-04 Code Changes 
 
07/15/2013 
Home Health TOB 33X 
 
07/02/2013 
TX/OK Tornado Update 
 
06/28/2013 
Outpatient Therapy Functional Reporting Non-Compliance Alerts 
 
06/26/2013 
Sequestration and Medicare Advantage 
 
06/25/2013 
New Telephonic Options for Providers 
 
06/25/2013 
Social Work and Psych Codes in CORFs 
 
06/12/2013 
Medicare Advantage Interactive Telephone Guide for Providers 
 
06/12/2013 
Frequently Used CPT Codes 
 
05/14/2013 
Administrative Fee Charges 
 
04/18/2013 
Home Infusion Clarification  
 
04/08/2013 
CPT 36415 Adjustments 
 
04/05/2013 
Precertifications, Observation and Timely Notification Reminders for Medicare Advantage Members 
 
04/02/2013 
Surgical Modifiers  
 
03/29/2013 
Corrected Claims Guidelines  
 
03/13/2013 
Place of Service Billing 
 
03/11/2013 
Sequestration and Medicare Advantage 
 
03/04/2013 
Notice of Medicare Non Coverage to a Skilled Nursing Facility 
 
03/01/2013 
Important Reminder Regarding CPT 80101 
 
02/25/2013 
Ordering/Referring NPI Requirements 
 
02/20/2013 
2013 Psychiatry Codes 
 
02/01/2013 
Hurricane Sandy Claims Update  
 
02/01/2013 
Medicare Advantage eUpdates  
 
02/01/2013 
RX Monitoring 
 

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