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Industry News: Blue Cross Blue Shield

Ordering lab tests, which are not medically necessary or investigational
Thursday, December 01, 2011

Effective January 20, 2012, coding updates in the claims system for some Genetic/Laboratory Testing policies may result in investigational/not medically necessary determinations resulting in expanded out-of-pocket costs to your patients.

U.S. Sues Michigan Blue Cross Over Pricing
Wednesday, October 27, 2010

The Justice Department sued Blue Cross Blue Shield of Michigan on Monday, asserting that the company, the state’s dominant health insurer, had violated antitrust laws and secured a huge competitive advantage by forcing hospitals to charge higher prices to Blue Cross’s rivals.

The civil case appears to have broad implications because many local insurance markets, like those in Michigan, are highly concentrated, and Blue Cross and Blue Shield plans often have the largest shares of those markets.

Blues highlight medical, benefit policy changes
Friday, October 01, 2010

You’ll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart.
This billing chart is organized numerically by procedure code. New procedures that are not covered will appear under Experimental Procedures.

EXPERIMENTAL PROCEDURES

84999
Because there is no code for this service, this procedure should be reported with this not otherwise classified code.

Basic Benefit Policy

Horizon BCBS Modifier Cut May Threaten Your Income
Wednesday, March 31, 2010

As a result, the Medical Society of New Jersey (MSNJ) has filed a compliance dispute against Horizon alleging multiple violations of the national class-action settlement agreement concerning these modifiers.

The Horizon BCBSNJ memo announced that this change will become effective on May 17, 2010, and will recognize services submitted with a variety of modifiers as “nonstandard” and “not performed” or pay for the services at significantly discounted amounts.

Units of Service validation begins on December 15, 2009
Thursday, March 04, 2010

Units of Service validation editing for procedure codes submitted from professional providers (837P or 1500 Health Insurance Claim Form) begins on the evening of December 15, 2009. Although Blue Cross and Blue Shield of Minnesota and Blue Plus are not following Medicare’s Medically Unlikely Edits (MUE), this is similar to MUEs where the verbiage of the procedure code dictates the number of units that should be submitted per line item, per date of service.

Blue Cross Blue Shield of Kansas Updated LCDs
Thursday, February 04, 2010

Medicare Kansas has retired the following LCD / HER-2/NEU GENE AMPLIFICATION AND OVEREXPRESSION TESTS effective 4/13/2005.

The procedure codes are:

  • 88342
  • 88367
  • 88368
  • 174.0 to 174.0
  • 174.2 to 174.2
  • 174.3 to 174.3
  • 174.4 to 174.4
  • 174.5 to 174.5
  • 174.6 to 174.6
  • 174.8 to 174.8
  • 174.9 to 174.9
  • V70.1 to V70.9
  • V72.81 to V72.84
  • 174

Anthem Blue Cross CA-Serum Tumor Markers
Wednesday, January 27, 2010

This document addresses serum tumor markers in the management of cancerous conditions.

Serum tumor markers are molecules or substances that are produced by the tumor itself or by the body in response to the presence of a cancerous or non-cancerous condition. These markers can be detected and quantified in the serum.

Lab sued for Fraud by New Jersey Blue Cross Plan
Tuesday, November 24, 2009

On June 25, 2009 Horizon Blue Cross Blue Shield of New Jersey filed a civil suit in New Jersey Superior Court against Biodiagnostic Laboratory Services of Parsippany, N.J. for allegedly submitting more than $14 million in fraudulent health insurance claims to Horizon between 2005 and June 2009 (Horizon Blue Cross Blue Shield of New Jersey v. Biodiagnostic Laboratory Services LLC).

The complaint alleges violations of the New Jersey Insurance Fraud Prevention Act (IFPA) and common law claims for fraud, negligent misrepresentation, and tortious interference.

Blue Cross Blue Shield Settlement
Tuesday, November 24, 2009

The final appeal in the Blue Cross Blue Shield Settlement was dismissed on June 12, 2009 and as such, the settlement has been finalized. The settlement administrator mailed the settlement checks to class members on July 22, 2009.

* CODING PROVISIONS IN BLUE CROSS BLUE SHIELD ASSOCIATION SETTLEMENT TAKE EFFECT JANUARY 21, 2009

The provisions in the Settlement Agreement reached between physicians and the Blue Cross Blue Shield Association requiring the settling Blues companies to follow most CPT® rules take effect on January 21, 2009.

Physicians Affected by BCBS Data Breach
Tuesday, November 24, 2009

A file containing unencrypted identifying information for every physician in the country who contracts with a BlueCross BlueShield-affiliated insurance plan was on a laptop computer stolen from an employee’s car Aug. 27. The file contained names, addresses, tax identification numbers and national provider identifier (NPI) numbers for about 850,000 physicians, said Jeff Smokler, spokesman for the Chicago-based Blues assn. BCBS notified its affiliates about the possible breach a week after the theft occurred, and put them in charge of notifying network physicians.