Billing News Aug 2017



"Upload document" feature for Provider Web Portal prior authorization requests

  • August 30, 2017

Soon, the Provider Web Portal at https://www.or-medicaid.gov will allow providers to upload required documentation when they submit a prior authorization request. You can upload a scan or text file of the documentation. Supported files are .TXT, .PDF and .TIF/.TIFF. This means you can submit all information and documents in one request. No more...

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Prior Authorization Requirements

  • August 30, 2017

The following laboratory procedure codes that are being added to the MA Program Fee Schedule will require prior authorization: New Genomic Sequencing Codes 81413 and 81414 plus Multianalyte Assays with Algorithmic Analyses (MAAA) code  81512. These updates are described in the MA Provider Handbook which may be viewed online at: http://www.dhs...

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Updated the Prior Authorization Manual-Genetic testing

  • August 30, 2017

Most genetic testing CPT codes have pended for pre-payment review by South Dakota Medicaid. In order to allow providers to more accurately determine if a service will be covered before provision of the service and to simplify claims processing, South Dakota Medicaid is revising this process to require prior authorization for most genetic testing...

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New prior authorization program called Genetic Testing Solution

  • August 30, 2017

Anthem Blue Cross announced a program to promote "appropriate use" of genetic tests and improve the efficiency of prior authorizations. The program, called Genetic Testing Solution, will be administered by specialty benefits manager AIM Specialty Health, and is aimed at promoting "appropriate use" and providing "education that addresses the...

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New Process for Submitting HbA1c Values Between Seven and Eight Percent

  • August 30, 2017

In order to close gaps in care for patients with Hemoglobin A1c (HbA1c) values between seven and eight percent, a new process has been implemented. It is required that the HbA1c value be submitted on the claim; however, there is not currently a code available to close a gap for these values. We are now accepting additional information from...

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Delayed: Bundling by Tax ID and Specialty Claim Edits Standardization

  • August 30, 2017

On June 27, 2017, a notification was distributed regarding an August 1, 2017, implementation date to apply bundled edits to all providers under the same Tax ID with the same specialty. This is currently on hold. A new communication will be sent once a new date is available.

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Important information for providers ordering genetic testing

  • August 30, 2017

BCBSGa transitioned the medical necessity review of all genetic testing services to AIM Specialty Health® (AIM), a separate company, beginning with dates of service on an after July 1, 2017. This program applies to local BCBSGa fully insured members. Medical necessity reviews take place as a prior authorization. To reduce administrative delays, it...

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Prior authorization for genetic testing for MA members effective Nov. 1

  • August 30, 2017

Effective with dates of service on or after Nov. 1, 2017, BCBSGa will transition the medical necessity review of all genetic testing services for individual Medicare Advantage members to AIM. Additionally, this review will now take place as a prior authorization. Additional information will be available at bcbsga.com/medicareprovider at Important...

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