Summary
From the 1st quarter 2018 Blue Cross and Blue Shield of Louisiana provider update. Beginning March 1, 2018, providers are required to use self-service tools for member eligibility (not benefits), claim status inquiries, professional allowable charge searches and medical policy searches, which are no longer initially handled through the Customer Care Center. Blue Cross will reimburse up to a maximum of 30 hours of observation billed with HCPCS code G0378, and telemedicine services are not reimbursable when delivered by audio-only telephone, fax or email.
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What to do
Action · 17 steps
01Already effective March 1, 2018: Use iLinkBlue, Interactive Voice Recognition at 1-800-922-8866, or HIPAA 27x transactions for member eligibility and claim status.
02For eligibility, provide the member's effective or termination date.
03For paid or rejected claims, provide the amount paid or ineligible amount, code and claim number.
04For pended claims, provide the claim number and pended reason.
05Observation: Use HCPCS code G0378 when billing for observation.
06The 30-hour count begins when outpatient services begin, when the member arrives at the hospital for treatment, not when the observation stay begins.
07Telemedicine: Telemedicine encounters must be fully documented and analogous to an in-person, face-to-face encounter, and any deviation from the normal standard of care must be documented and addressed in the plan of care.
08Prescribing controlled substances during a telemedicine encounter is not permitted except as authorized by law.
09Place of service is based on where the member is located when the service is performed, typically POS 12 for home.
10To be eligible for reimbursement, the rendering provider must be a BCBSLA network provider and follow the telemedicine guidelines of the appropriate licensing board.
11Providers who do not follow proper telemedicine procedures may be subject to lower allowables, network status changes, point-of-sale rejections for prescription drugs, or rejection of services performed.
12Correction: The admission and discharge time instruction for outpatient emergency room claims was incorrect.
13Continue to file according to the ANSI X12 HIPAA guidelines.
14Effective April 9, 2018: Requests to join or maintain network participation, including credentialing and recredentialing, must be submitted on appropriate applications, and incomplete applications or applications with missing documentation are no longer accepted.
15Provider file maintenance requests must be submitted on the appropriate Blue Cross form, and notifications on other document types, including provider letterhead, are no longer accepted.
16Credentialing applications are returned upon receipt for reasons such as no original signature, a signature 180 days old or greater, or no effective date listed.
17Check current applicability of these historical rules before acting.
Codes mentioned
157303125338573C97381573331257C9748192943125955874209393129858575312413299438222C974981541J2326P9073812698155197127J0565J2350P910074021812838600897763J0604J3358Q04778132886794J0606Q204087634J1428J72968134687662J1555J734590756J16278123881448C9024J1726J920395249C9028J1729J9285C9462C9464C9466C9468Q2041Q5104C9463C9465C9467C9469Q5103G0378
Original notice
Network News - 1st Quarter 2018
providers.lablue.com · Always check the source before changing claims.
Related changes
See all Blue Cross and Blue Shield of Louisiana changes →Network News - 3rd Quarter 2019MediumEffective Nov 1, 2019 · Provider NewsNetwork News - 4th Quarter 2017MediumEffective Dec 1, 2017 · Provider NewsNetwork News - 3rd Quarter 2022MediumNo effective date · Provider NewsNetwork News - 2nd Quarter 2024MediumNo effective date · Provider NewsBrowse every Blue Cross and Blue Shield of Louisiana change in the policy list
Related policy hubs
Blue Cross and Blue Shield of Louisiana policiesLA policy changesCode 15730Code 31253Code 38573Code C9738Code 15733Code 31257Code C9748Code 19294Code 31259Code 55874Code 20939Code 31298Code 58575Code 31241Code 32994Code 38222Code C9749Code 81541Code J2326Code P9073Code 81269Code 81551Code 97127Code J0565Code J2350Code P9100Code 74021Code 81283Code 86008Code 97763Code J0604Code J3358Code Q0477Code 81328Code 86794Code J0606Code Q2040Code 87634Code J1428Code J7296Code 81346Code 87662Code J1555Code J7345Code 90756Code J1627Code 81238Code 81448Code C9024Code J1726Code J9203Code 95249Code C9028Code J1729Code J9285Code C9462Code C9464Code C9466Code C9468Code Q2041Code Q5104Code C9463Code C9465Code C9467Code C9469Code Q5103Code G0378