Advanced Beneficiary Notification (ABN) Language Removed from Blue Advantage Agreements

BCBSAL recently sent a letter to all of their Blue Advantage providers regarding the removal of the ABN language from all Blue Advantage agreements. Per this requirement from CMS, providers may bill a Medicare Advantage member for potentially noncovered services, but only after a Pre-Service Organization Determination Request has been submitted and a Standardized Denial Notice has been provided to the beneficiary from Blue Cross. A Pre-Service Organization Determination is not required for statutorily excluded services that have been clearly communicated to the beneficiary.

Source: https://providers.bcbsal.org/portal/news