Please see the link below for the BCBS of IL September updates.

BCBS of IL – Blue Review (Sept 2022)

General New

• Medica encourages members to receive their flu vaccine. Additional information from the CDC related to seasonal flu vaccines available by following the link on the newsletter.

Clinical News

• Medical policies and clinical guidelines to be updated – Effective October 17, 2022: Updates to Medical Policies

Pharmacy News

• A link to the latest Summary of Changes is included:  Summary of Changes
• Medica to add new UM policies for 4 new medical pharmacy Drugs – Effective October 24, 2022 -J3490 Amvuttra, J9047 Kyprolis, J0897 Prolia/Xgeva and J3590 Skyrizi
• Be sure and review specific plan restrictions for the updates drug policies
• Upcoming changes to Medica Part D drug formularies – Effective September 1, 2022

Network News

• Effective 10/01/2022 Medica will implement standard ancillary fee schedule updates for all Medica products. This will impact several areas and these can be viewed by following the link to the newsletter.

Administrative News

• Provider administrative training webinar for September: Setup and Billing for Elderly Waiver and Housing Stabilization Providers. View the newsletter for details.
• The Provider Administrative Manual can be accessed by following the link on the newsletter.

Sept2022Conn – Final

Reimbursement update for COVID-19 antibody treatment bebtelovimab

Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. As a result, we did not reimburse for the drug itself when billed with Q0222.

However, on August 15, drug manufacturer Eli Lilly started commercial distribution of their COVID-19 monoclonal antibody therapy, bebtelovimab (175 mg), and the federal government will no longer purchase it. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with the Centers for Medicare & Medicaid Services rates for doses of bebtelovimab that they purchase directly from the manufacturer. Reimbursement for the administration of the injection will remain the same.

Reimbursement rates are as follows:

• Q0222 (175mg for the drug): $2,394
• M0222 (administration in facility setting): $350.50
• M0223 (administration in home setting): $550.50

Virtual care billed by urgent care centers

As a reminder, we stopped reimbursing virtual care services provided by urgent care centers on March 13, 2022 when billed with a global S9083 code. However, due to feedback received from urgent care centers, we resumed reimbursing urgent care centers for virtual care services billed with a global S9083 code for all dates of service, effective August 13, 2022.

Virtual care services provided by urgent care centers with code S9083 that were that were denied between March 13, 2022 and August 13, 2022 will be automatically reviewed and adjusted to be covered, as applicable. Claims that are reimbursable as part of that review will be automatically reprocessed to pay. There is no action needed by urgent care centers to have claims reviewed, reprocessed, or reimbursed.

Virtual care place of service requirement reminder

As a reminder, we now recommend providers bill virtual care services using Place of Service (POS) 02. We recently updated our systems to ensure providers receive 100 percent of face-to-face reimbursement for covered virtual care services when using POS 02.

Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits.

Please also note that we continue to request that providers do not bill POS 10 (or Modifiers 93 or FQ) for virtual care at this time. While POS 10 should not be denied nor reduce reimbursement, it will not reduce your patients’ cost-share.

Public health emergency period

As a reminder, to align with the current end date of the federal public health emergency (PHE) period, the cost-share waiver for diagnostic COVID-19 testing and testing-related services is in place through October 13 for individuals with Cigna commercial and Cigna Medicare Advantage benefit plans

Cigna – latest COVID-19 updates – August 2022

MO HealthNet will be offering brief webinars, which will cover Telemedicine

Please click the link below to view the Telehealth training schedule and to sign up to attend.

MO Healthnet- Telehealth Trainings 2022

Blue Review August 2022 Newsletter

BCBS of IL – Blue Review (Aug 2022)

Electronic Options

• New Online Option to Confirm Medical Record Receipt Status
• Check Eligibility and Benefits: Don’t skip this important first step!

Pharmacy Program

• Quarterly Pharmacy Changes Effective July 1, 2022 – Part 2
• Prior Authorization Changes Effective October 2022

Wellness and Member Education

• Share Facts About Immunizations with Your Patients in August

Community Involvement

• 2022 Back to School Events at Our Blue Door Neighborhood Center^SMLocations

Focus on Behavioral Health

• Behavioral Health Support Resources: Maternity Program for Blue Cross Community Health Plans^SM(BCCHP^SM) Members

Provider Education

• Provider Learning Opportunities
• Has your information changed? Let us know!

Claims and Coding

• New Laboratory Management Program to Begin Nov. 1, 2022
• Reminder: CPT^®Codes May Change

Claims and Coding

• Reviews on Inpatient DRG Claims for BlueCard^®(Out of Area) Medicare Advantage Members
• Illinois Medicaid Providers: Confirm Certifications and Licensure are Active in the IMPACT System

Clinical Updates, Resources and Reminders

• Medicaid Reminder: HFS Reinstatement of Certificate of Transportation Services (CTS) Form, Effective June 1, 2022
• Use Our New Prior Authorization Digital Lookup Tool for Medicaid Member Information

Quality Improvement and Reporting

• Blue Distinction^®Centers for Cancer Care

Please find attached the revised provider commination surrounding the Dispute and Appeal Process.  It has been updated to show Peer to Peer process and when it should be used.

Healthy Blue- Claims Dispute and Appeals process_FINAL July 2022

Please let you staff know of these changes and share the document or it may also be found at the following link:

https://provider.healthybluemo.com/missouri-provider/resources/forms

There has been an update to the BJC Employee Plan, Account # 3335018.  The plan has decided to allow Mercy hospital services at the in-network benefit level dating back to 1/1/2021.

What this means to you –

• All prior claims that processed Out of Network, will be reprocessed as In Network according to the OAP contract rate with a retro effective date of 1/1/2021.

• Cigna has started reprocessing claims for the BJC employee account.  Beginning December 20th, you will start to see corrected and adjusted EOBs.

• Mercy will now see the BJC Employee Plans appearing as In-Network on Cignaforhcp.com and this information will be shared when calling into Cigna to verify eligibility and benefits.

• Please allow up to 60 days for the full reprocessing of the BJC Employee claims.

• Claim inquiries and appeals should be directed to Cigna Customers Service.

• As of 1/1/2022, Mercy will be in-network for BJC’s benefit plan, unless a BJC employee has elected the LocalPlus plan, then the participating providers in LocalPlus will be in-network for those BJC employees with LocalPlus.

It has recently been brought to our attention that our phone carrier is presently having technical issues with some of our Fax lines; they are presently ringing busy.  One of the fax lines that is impacted is our Medicaid medical prior authorization intake line.

If you have a medical prior authorization that you need to fax in, please fax it to: 800-577-1074.

We recognize the inconvenience on you and your office staff, and as we continue to work through this outage, we ask that you also consider leveraging the Availity portal to submit authorizations.

Billing outpatient and inpatient charges update:

Effective November 1, 2022, Healthy Blue will begin to implement billing edits that will now require outpatient services rendered prior to an inpatient admit, to be billed separately from the inpatient charges. All outpatient services should be submitted on one claim while all inpatient services should be submitted on a separate claim.

Any claims received not following the guidance provided will result in a rejected claim. This notification is to provide advance notice on this policy change to allow time for you to make the necessary system updates.

If you have questions about this communication or need assistance with any other item, contact your assigned Provider Experience consultant or call Provider Services at 833-405-9086.

Connecting Evernorth and our Behavioral Health Care Providers

• The loneliness epidemic persists among adults
• Teen mental health takes toll on parents at work
• COVID-19: Interim guidance for behavioral providers
• Medicare Advantage growth offers more practice opportunities
• CAA and keeping your patients informed
• Digital solutions: Procedure code benefit lookup for PPO policies
• Frequently asked questions: EAP administration
• Cigna + Oscar Health plans

See bulletin attached for more details.Evernorth- July 2022 Bulletin