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    • July 1, 2013

    Drug screening procedure codes G0431 and G0434 should be billed only once per patient encounter. • G0431 – Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter. • G0434 – Drug screen, other than chromatographic; any number of drug classes, by... more

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    • July 1, 2013

    On Monday, April 1, 2013, CMS implemented a two percent reduction in their Medicare provider payments as part of “sequestration” required by the Budget Control Act. Payments from the Federal Employee Program (FEP) will be impacted where FEP acts as a secondary payer to a Medicare primary claim. Medicare Assigned Claims   ... more

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    • February 28, 2014

    The following new clinical guideline for Drug Testing or Screening in the Context of Substance Abuse and Chronic Pain will require medical necessity review, effective May 7, 2014. Although a predetermination is not required, Anthem encourages providers to obtain one prior to performing any of the following CPT codes: 80100, 80101, 80104, 80102,... more

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    • February 28, 2014

    Anthem Blue Cross and Blue Shield reviews its professional reimbursement policies annually to determine if any changes or revisions are required. The Health Plan effective May 19, 2014 will add a frequency limit of once per date of service for the following CPT and HCPC codes: 81479 Unlisted molecular pathology 36415 Collection of venous blood... more

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    • March 18, 2014

    In an effort to better service contracted providers right the first time, Anthem Blue Cross has improved their provider claim escalation process. Just click, Provider Claim Escalation Process to read, print, download and share the improved process with your office staff. The Network Relations Team is available to answer questions you have about... more

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    • March 18, 2014

    In October, Anthem Blue Cross implemented new guidelines to help reduce the administrative work associated with Medicare crossover claims filing. CMS has a list of statutorily excluded services or services that Medicare will not reimburse. CMS has established a GY modifier to indicate to secondary and tertiary payers a statutorily excluded service... more

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    • March 18, 2014

    The following new clinical guideline will require medical necessity review, effective May 7, 2014. Although a predetermination is not required, BCBSKY encourage providers to obtain one prior to performing any of the procedure: Name Drug Testing or Screening in the Context of Substance Abuse and Chronic Pain Added to Clinical Guideline CPT... more

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    • April 23, 2014

    Effective for claims with dates of service on or after July 1, 2014, the Frequency Editing reimbursement policy will be updated to add a limit of one, per date of service, for 81479 (unlisted molecular pathology). This edit agrees with information contained in the CPT® Assistant newsletter, September 2013 issue, page 3.

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