Provider News

AIM's 2013 Holiday Schedule

(Posted 1.2.13) American Imaging Management®, BCBSNE's RQI program administrator, will be closed on the following holidays in 2013:

Monday, Jan. 21  Martin Luther King, Jr. Day 
Monday, May 27 Memorial Day
Thursday, July 4 Independence Day 
Monday, Sept. 2 Labor Day
Thursday, Nov. 28  Thanksgiving Day
Friday, Nov. 29 Day after Thanksgiving 
Wednesday, Dec. 25 Christmas Day

 

BCBSNE Billing Requirements for Breastfeeding Support, Supplies and Counseling
 

8/1/2012 Effective August 1, 2012, benefits will be provided for breastfeeding support, supplies and counseling at no cost to the member when obtained from an in-network provider and following the billing and coding guidelines specified below:   

Breast Pump Billing Guidelines

  • E0602 Breast pump, manual, any type
  • E0603 Breast pump, electric (AC and/or DC), any type
  • E0604 Breast pump, hospital grade, electric (AC and/or DC), any type

The HCPCS code must be appended with modifier RR or NU to indicate rental versus purchase.

Benefits will be provided for one pump, per pregnancy, at no cost to the member.  
Benefits are also available for the following breast pump supplies on a purchase-only basis:

  • A4281 Replacement breast pump tubing
  • A4282 Replacement breast pump adapter
  • A4283 Replacement of breast pump cap  
  • A4284 Replacement breast pump shield
  • A4285 Replacement of breast pump bottle
  • A4286 Replacement of breast pump locking ring

Breastfeeding Support and Counseling Billing Guidelines

The following CPT/HCPCS codes are appropriate for lactation support and counseling services provided by an IBCLC: 99211, 99401, 99402, 99403, 99404 or Lactation Classes: S9443, 99411, 99412. 

The following CPT codes are appropriate for lactation support and counseling services provided by an MD: 99211, 99401, 99402, 99403, 99404 or Lactation Classes: 99411, 99412. 

In order for benefits to be paid at 100 percent, V24.1 must be the primary diagnosis code on the claim. There is no limit in the frequency or number of counseling sessions or classes payable under this benefit. 

Note:  Lactation services, including breast pumps and supplies, provided to a covered member during an inpatient hospitalization is considered inclusive in the reimbursement made to the hospital and cannot be billed separately.

Network Requirements

Individuals who are designated as an International Board Certified Lactation Consultant (IBCLC) are eligible to apply to become a participating provider with BCBSNE, and must meet all credentialing requirements as established and approved by the BCBSNE Credentialing Committee.  To apply, complete the Universal Application and Practitioner Authorization forms.  A Provider Agreement may be requested from HealthNetworkRequests@nebraskablue.com.

IBCLCs who are a salaried employee of a hospital or home health agency are still required to be credentialed by BCBSNE and file claims under their own name and individual NPI number.

Questions regarding credentialing should be sent to CredentialingRequests@nebraskablue.com.


Guidelines for Anesthesia Services Provided by CRNAs Employed by a Hospital

3/11/2010 Effective immediately CRNAs who are an employee of a hospital will need to obtain an NPI and advise BCBSNE of their NPI for claim filing. NPI notification forms are available online. In addition to needing their individual NPI, we need their date of birth and social security number. Once we have received this information, we will update our provider files.

Services provided by a CRNA who is an employee of a hospital must adhere to the following billing guidelines:

  • Anesthesia claims must be billed with minutes not units
  • Never put the surgeon’s NPI number on the claim
  • Do not write start and stop times on the claim

Paper claims guidelines:

  • Box 24J must include the CRNA’s individual NPI
  • Box 31 must include Prof Serv CRNA with the CRNA’s first and last names underneath Prof Services CRNA
  • No punctation
    • Example:
      • Prof Serv CRNA
      • Smith Jane CRNA
      • Box 33A must include the entity’s NPI number

      Electronic claim guidelines:

      • The 2310B Loop (Rendering) should include the CRNA’s name and individual NPI
      • The 2010AA Loop (Billing) should include the billing entity’s name and organizational NPI
         

      Billing Guidelines for Supervised Mental Health Providers

      3/11/2010 Effective immediately supervised mental health providers will need to obtain an NPI and advise BCBSNE of their NPI for claim filing. NPI notification forms are available online. In addition to needing their individual NPI, we need their date of birth and social security number. Once we have received this information, we will update our provider files.

      Mental Health Providers whose services are supervised must adhere to following billing guidelines:

      Paper claim guidelines:

      • Box 24J Rendering provider’s (not supervising) NPI in 24J
      • Box 31 Rendering provider’s first and last names and credentials with the supervising provider’s first and last names and credentials underneath it
      • No punctuation (commas or periods)
        • Example:
        • Smith Jan PLMHP
        • Supervised by Jones John LMHP

        Box 33A must include the Billing entity’s NPI. If there is not a Billing/Group/Type II NPI,an individual NPI can go in 33A Do not put the supervising practitioner’s NPI number anywhere on the claim!

        Electronic claim guidelines:

        • The 2310B Loop (Rendering) should include the Rendering Provider’s name and individual NPI
        • The 2010AA Loop (Billing) should include the billing entity’s name and organizational NPI

        Providers requiring supervision include: Certified Social Worker, Psychiatric Registered Nurse, Provisional Licensed Mental Health Practitioner, Provisional PhD, Provisional Certified, Master Social Worker, Provisional Alcohol and Drug Counselor or other approved provider who is performing services within his or her scope of practice and who is supervised, and billed for, by a qualified Physician or Licensed Clinical Psychologist, or as otherwise permitted by state law. Certified Master Social Workers or Certified Professional Counselors performing Mental Health Services who are not Licensed Mental Health Practitioners are included in this definition.