The Record

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All Providers

July 2018
Picture of physician

Here’s an update on Blue Distinction Specialty Care
We wanted to remind you about this important Blue Cross and Blue Shield Association designation program and let you know how the program has changed over the past year. Read more.

Inside this issue for you

Provider training survey

We want your opinion on provider training and education. Help us meet your training needs by completing a short five-minute survey by July 31, 2018.

See all the articles in this issue, grouped by category, below.

Professional

We encourage you to join PGIP as a physician organization
Improve HEDIS scores, reduce medical record requests through proper claims coding
2018 Clinical Quality Corner tip sheets posted on web-DENIS
Talk with your patients about importance of complying with statin therapy
Coding corner: Diabetic eye disease
FEP provides pregnancy care incentives, promotes healthy lifestyles
We’ve made changes to Benefit Explainer
Outpatient facilities added to Medicare Plus Blue prior authorization program
Six additional drugs to be added to commercial PPO 15-day Specialty Drug Limitation Program, starting Aug. 1
Authorization for Fasenra™ and Luxturna™ required for Medicare Advantage members starting in August
Commercial Medical Drug Prior Authorization Program adds Ilumya™
Reminder: Update Provider Authorization Form when changes occur with your 835 ERA routing destination
Use modifier 96 for habilitative services

All Providers

Here’s an update on Blue Distinction Specialty Care
Members who don’t meet criteria for covered services pay only the amount allowed by Blue Cross
Battling the opioid epidemic: A roundup of news and information
HCPCS update: New codes added
Effective July 1, use new procedure code Q9995 for anti-hemophilia drug
Effective July 1, use new procedure code Q9993 when billing for Zilretta^®
Billing chart: Blues highlight medical, benefit policy changes

Pharmacy

Six additional drugs to be added to commercial PPO 15-day Specialty Drug Limitation Program, starting Aug. 1
Authorization for Fasenra™ and Luxturna™ required for Medicare Advantage members starting in August
Commercial Medical Drug Prior Authorization Program adds Ilumya™

Facility

Beginning in July, PPO inpatient admission requests submitted through e-referral could be subject to clinical review
We encourage you to join PGIP as a physician organization
Reminder: Notify Medicare Plus Blue PPO members about their rights if post-acute care services will be terminated
Outpatient facilities added to Medicare Plus Blue prior authorization program
Reminder: Update Provider Authorization Form when changes occur with your 835 ERA routing destination
Comply with semiannual request to update or confirm demographic data
Use modifier 96 for habilitative services

DME

Clarification: Requirements for providers billing DME prosthetics, orthotics and supplies
Additional codes added to capped rental list

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