News Tags: Anthem BCBS Wisconsin
Medical necessity review for Drug Testing or Screening in the Context of Substance Abuse and Chronic Pain
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
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
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
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
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