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Providers

Alerts and Updates

Stay up-to-date on the latest. Updates serve as an amendment to your provider agreement and contractual relationship. Please file each issue below and keep it with your policies and procedures manual.

Happening Now

Stay up-to-date on the HealthRules transition and updated policies in light of the COVID-19 pandemic. 
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Recent Updates

July 2021 Update
Ambulance de-credentialing, Expanded requirements for genetic and molecular testing, New benefit changes for multiple sclerosis medications, Documenting and coding for depression, Billing for sepsis and more.

May 2021 Update
Pharmacy update, ASC claims billing, Credentialing for Licensed Medical Nutrition Therapists (LMNT), Peer-to-peer calls, Coding for diagnostic radiology and lab tests and more.

March 2021 Update
Save feature added to preauthorization tool, Peer-to-peer reminders, Medical record review, Weight-related diagnosis coding and documentation, Changes to oncology medication reimbursement tiers and more.

January 2021 Update
Out-of-state members and preauthorization, risk adjustment data validation audit (RADV), HEDIS medical record reviews starting, multiple surgery claims, timely filing and medically unlikely edit (MUE) denials, and intraocular lens implants.

December 2020 Update
Training for enhanced preauthorizations, facility accreditation, correcting professional claims, returned claims and more.

November 2020 Update
Happening now, COVID-19 updates, timely filing, evaluation and management codes, billing, clinical, credentialing, pharmacy and risk adjustment and risk management updates.

September 2020 Update
Coronavirus (COVID-19) updates, Happening Now, telehealth provider characteristics, Documenting Pediatric Hierarchical Condition Categories and reminders.

July 2020 Update
Coronavirus (COVID-19) updates, Happening Now, enhancements to online preauthorizations coming fall 2020, site-specific modifies and NaviNet Insider.

May 2020 Update
Coronavirus (COVID-19) updates, taxonomy required on all claims, medical claim status questions, modifier 25, immediate family members, medicare advantage prior authorization update, ASC billing invoices, bilateral procedure billing and more.

March 2020 Update
Coronavirus (COVID-19) updates, telehealth, Federal Employee Program (FEP), bilateral procedure billing, therapy policy updated, new name for centers of excellence program, NaviNet tips, 2020 HEDIS Medical Record Review and more.

January 2020 Update
Medicare Crossover Claims, Provider Characteristics-Opioid Medication Assistance, Provider Characteristic Codes, Provider Tools, NaviNet, MedPolicy Blue, Inquire About Claims Online or By Phone and more.

December 2019 Update
HealthRules, CareFirst, Virta and Type 2 Diabetes Pilot Program, Medicare Advantage Expansion, HEDIS Medical Record Reviews Begin in February 2020, FEP Hospice Benefits, FEP 2020 Blue Distinction Benefit and more.

November 2019 Update
Armor Health, Therapy Payment Policy, Opioid Epidemic and Drug Abuse: Member Lock-in Program, Patient-Driven Payment Model and more.

September 2019 Update
Site of care for medical infusions policy, carpal tunnel payment policy, Happening Now and more.

July 2019 Update
New out-of-network facility in Millard, Emergency Department Utilization, reminders and more.

May 2019 Update
A special announcement to providers, Provider Service Improvements, NICU Levels of Care No cost to adjust/reconsider claims, Taxonomy code requirement and more.

March 2019 Update
Updated Reconsideration Request and Appeal Request Forms, Chiropractors and Physical Therapy - Maintenance Therapy (Amended), and more.

January 2019 Update
Claim Return Letters, Seven-day limit for opioid drugs, Peer-to-peer phone calls, Mark your calendar, Collaborative support for patients with diabetes, and more.

November 2018 Update
Hyaluronic acid injections products, high dollar review, mental health coverage, school place of service, BlueCard Bulletin, BCBSNE and FEP transition to new platforms, health fairs, FEP Blue Focus and more.

September 2018 Update
Sildenafil, reimbursement policies, colorectal cancer screenings, Fall provider conference, preauthorization requests, chiropractor and physical therapy, medicare record submissions and more.

July 2018 Update
Provider Executives, risk adjustment data validation, Bi-Partisan Budget Act, Preauthorization for Medicare Advantage and more.

May 2018 Update
Regional provider conference, pharmacy changes, policies and procedure updates, med policy blue, blueprint health, CMS mass adjustments, modifier -90 and more.

March 2018 Update
New CEO, walk at lunch, medical record retrieval, blue distinction for fertility care, RADV audit, late charges and replacement claims, change of address, appeal requests, mid-level reimbursement and more.

January 2018 Update
Alpha-numeric prefixes, testicular hypofunction, teleservices, FEP change, Gold Card Provider Program, mobile enhance maternity care program and more.

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