Summary
Blue Cross expanded its musculoskeletal utilization management program to joint surgery for large joint replacement and arthroscopy of the hip, knee and shoulder. AIM Specialty Health accepts pre-service authorization reviews for these services starting August 27, 2018, for dates of service on and after September 1, 2018. Claims received without a preservice authorization will be denied for a post-claim review, and beginning October 27, 2018, joint surgery services that do not meet criteria will be denied as not medically necessary and are not billable to the member. The newsletter also lists outpatient code range updates effective July 1, 2018, HCPCS and DME allowables effective July 1, 2018, updated drug allowables for dates of service on and after September 1, 2018, and a new claims editing system targeted for completion by the end of November 2018.
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