News Tags: Anthem BCBS New Hampshire
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
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
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.
Recently, you may have received a remittance that indicates that a BlueCard (out-of-area) claim had been adjusted. However, there were no changes to the reimbursement. This claim was adjusted to reconcile some of Anthem's BlueCard program claims internally. There were no processing errors, and there is no action required on your part.
Effective for dates of service on or after November 24, 2014, Anthem will implement a new policy titled Surgical Pathology and Related Prostate Needle Biopsy. This policy outlines Anthem’s position that the maximum number of units allowed for surgical pathology code 88305 will be nine units when reported with a prostate diagnosis. HCPCS... more
The Laboratory and Venipuncture Services policy was updated to include the following information already included in the Frequency Editing Reimbursement Policy. The frequency limit allowing CPT codes 36415, 36416 and S9529 once per date of service, will also apply to any combination of these codes reported on the same date of service for the same... more
Three-Dimensional (3D) Radiology Services (formerly 3D Rendering of Imaging Studies), Bundled Services and Supplies, and Modifier 59 (Distinct Procedural Service)
Anthem considers 3D rendering of imaging studies to be a technology and technique improvement that represents an aid to the physician via computer generated real-time study interpretation and decision support. These visual enhancements are considered an elective component of the overall imaging study performed and are not eligible for separate... more
Effective January 1, 2015, CMS is adding four new HCPCS modifiers to selectively identify subsets of modifier 59 for Distinct Procedural Services as follows: XE Separate Encounter: a service that is distinct because it occurred during a separate encounter XP Separate Practitioner: a service that is distinct because it was performed by a... more
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