Loading...Loading...In addition to the summary of monthly changes below, please also review our monthly Bulletin for recent and upcoming changes to our medical and reimbursement policies, Clinical Position Statements and associated changes to pre-authorization requirements. The Medical Policy Manual includes a list of recent updates and archived policies. Monthly change summaries are added to our website within 10 business days of our newsletter publication.
Review other monthly changes for 2022.
Listed below is a summary of medication policy additions and changes. Links to all medication policies, medication lists and pre-authorization information for our members, including real-time deletions from our pre-authorization lists, are available on our website.
Revised medication policy effective May 25, 2022
Non-Preferred Injectable Insulins, dru372
Read the August 2022 issue of our newsletter for details.
Effective May 1, 2022, we increased reimbursement rates for hearing aids. We have established higher caps for reimbursement of HCPCS V5221 and V5254-V5261. The new rates apply to dates of service May 1, 2022, and later; they will not be applied retroactively. n/a BSH: This change applies to all commercial plans that do not specify a benefit limit.
To verify a member’s benefit amount, check Availity Essentials.
The following sections of our Administrative Manual were updated effective May 16, 2022 for Regence BCBSO and Regence BCBSU only:
- Hospice VBID Model
Facility Guidelines
The following changes were made to our pre-authorization lists effective May 1, 2022.
Commercial and Uniform Medical Plan
- Evaluating the Utility of Genetic Panels (#GT64)
- 81324-81326
- Genetic and Molecular Diagnostic Testing (#GT20)
- 81324-81326
Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies (#GT66)
- 81324-81326, 81448
Medicare Advantage
Power Wheelchairs Group 2 and Group 3 (PWC) (#M-DME37)
- K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843
Please review our pre-authorization lists for all updates and pre-authorize services accordingly. You can submit standard medical pre-authorizations through Availity Essentials. Learn more about electric authorizations.
We reviewed the Preventive Services Guideline for Adults Clinical Practice Guideline, effective May 1, 2022. View our Clinical Practice Guidelines.
We publish updates to medical policies in our monthly publication, The Bulletin. You can read issues of The Bulletin or subscribe to receive an email notification when issues are published.
We provided 90 day notice in the February 2022 issue of The Bulletin about the following medical policy, which is effective May 1, 2022:
- Autologous Blood Derived Growth Factors as a Treatment for Wound Healing and Other Miscellaneous Conditions – Medicare Advantage (#M-MED77)
- Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (#TRA45.36)
Power Wheelchairs–Group 2 and Group 3 –Medicare Advantage (#M-DME37)
We publish updates to reimbursement policies in our monthly publication, The Bulletin. You can read issues of The Bulletin or subscribe to receive an email notification when issues are published.
We provided 90 day notice in the February 2022 issue of The Bulletin about changes to the Drugs, Immunizations/Vaccines, Radiopharmaceuticals, and Skin Substitutes Reimbursed Under Medical Coverage (Medicine #104) commercial and Medicare Advantage reimbursement policies, which are effective May 1, 2022.
Effective May 1, 2022, we will require all participating providers to receive claims payment via electronic funds transfer (EFT). Failure to receive claims payment via EFT is grounds for termination of the provider’s agreement with us. Use the Transaction Enrollment tool in Availity Essentials to enroll today at availity.com: My Providers>Enrollments Center>Transaction Enrollment. The Transaction Enrollment dashboard will display the status and progress of your enrollments.
Notes:
• Only your organization’s administrator, administrator assistant and users with the Transaction Enrollment role may enroll for EFT and change or update EFT setup.
• For security purposes, you will receive a phone call from our EFT enrollment team to validate the information you provide.
• If your EFT enrollment was completed prior to April 2021, your dashboard will not reflect that you are currently setup for EFT—only organizations that enrolled for EFT after April 2021 will show on the dashboard.
Learn more about EFT and view a step-by-step guide to enrolling or changing your EFT setup on our provider website.
Effective May 1, 2022, HCPCS J1951 and J9247 will be added to the specialty medication pre-uthorization lists for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members.
View the complete list of specialty medications that require pre-authorization for these members on our Commercial Pre-authorization List.
Effective May 1, 2022, we will require providers to submit a behavioral health intake form for the following:
• Initial intake
• Concurrent review
• Stepdown request to a lower level of care
• Discharge confirmation
Standardizing our behavioral health utilization management process will greatly reduce the turnaround time needed for reviews and approvals.
The new forms will be available on our provider website in April 2022. You will be able to submit them to our behavioral health team by email or fax. Additionally, initial intake forms can be attached to new initial pre-authorization requests in Availity Essentials.
Effective May 1, 2022, we will update reimbursement rates for applied behavior analysis (ABA) services provided to our commercial members (group and Individual products).
The updated reimbursement rates will be posted by May 1, 2022, in Availity Essentials: Claims & Payment>Fee Schedule Listing>Fee Schedules. Select the plan name and then enter the organization, tax ID and NPI. Click Next. Select the Actions button on the right to enter specific codes or a code range.