By Sarah Howarth, Billing Manager
BLUE CROSS OF WNY
Pay for Performance
2013 Pay for Performance checks were released during July. Performance scorecards are available at bcbswny.com/provider. The 2014 Pay for Performance program will focus on quality and be released by the end of the third quarter.
Medicaid Managed Care
Blue Cross has notified the Department of Health that they will no long offer Medicaid programs in Erie, Cattaraugus, Chautauqua, Orleans, Wyoming and Allegany counties. Practicefirst is monitoring the status of this decision and will keep you informed as it progresses. We are evaluating the potential impact to our clients. Please contact our office should you need assistance identifying your practice’s patients that have a Medicaid plan through Blue Cross.
Drugs and Vaccines
Univera has delayed the implementation of changes to their injectable drug reimbursement. Effective November 15, 2014, reimbursement rates for injectable drugs administered to members in Child Health Plus, Family Health Plus, PlusMed, a Medicare Advantage or Heathy NY product will be set at rates comparable to Medicare fee-for-service rates. Future updates will occur 45 days after the release of Medicare rates.
Please note vaccines for children covered by Child Health Plus or PlusMed should be obtained through the Vaccines for Children program. Only the administration fee is covered.
Effective October 1, 2014, Univera will require claims to contain the appropriate national drug code (NDC) and the number of NDC units for all unlisted or miscellaneous drug codes. Failure to include the NDC and number of units will result in a rejected claim.
Effective July 1, 2014, the customer care telephone number for Univera Commercial and Medicare Advantage lines of business is 1-866-265-5983.
EXCELLUS & UNIVERA
Clinical Editing Policy: Urinalysis with Evaluation & Management and Preventative Medicine.
This clinical editing policy identifies procedure codes for urinalysis without microscopy when billed with Evaluation and Management procedures including Preventative Medicine procedure codes. The justification for this policy considers urinalysis to be one of the most frequently used indicators of health and disease and is essential in the diagnosis and detection of renal and metabolic disorders. Like the measurement of blood pressure, it is considered an inherent component of an Evaluation & Management service performed in an outpatient setting. The limited resources required for the examination should be properly included, along with consideration of the obtained data in the selection of the appropriate level of E&M service intensity.
DEPT. OF HEALTH
Provider File Updates
Over the course of the next few months, the Department of Health will be conducting provider information verification to ensure provider information on file is current. If your office is contacted, please provide them with the necessary information. Items to be verified include:
-Provider phone number
-Line of business participation
For Billing questions, please contact Sarah Howarth at 716-348-3923 or firstname.lastname@example.org<