Summary
From the 4th quarter 2017 Blue Cross and Blue Shield of Louisiana provider update. For post-partum visits on and after December 1, 2017, obstetricians must submit a claim using non-payable CPT code 0503F with a charge of $0.00, and the visit should be performed no later than 60 days from the delivery date. Starting March 1, 2018, providers must use Blue Cross self-service tools for member eligibility, claim status inquiries, professional allowable charge searches and medical policy searches, and Blue Cross is changing its opioid drug coverage policy starting January 1, 2018 and as member benefit plans renew.
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What to do
Action · 16 steps
01Already effective December 1, 2017: Obstetricians bill globally for maternity care from the beginning of pregnancy through post-partum care.
02Submit the post-partum visit claim with CPT 0503F and a $0.00 charge.
03If 0503F is not billed to indicate post-partum care was performed, recoupments will be made to reflect the allowable applicable to the post-partum care service.
04Already effective March 1, 2018: Use iLinkBlue, Interactive Voice Recognition at 1-800-922-8866, or HIPAA 27x transactions for member eligibility and claim status.
05For member eligibility, provide the member's effective or termination date.
06You will be asked for additional information to verify that you attempted the self-service tools before the Customer Care Center will assist.
07Providers should not require the member or the member's attorney to guarantee payment of the entire billed charge, should not require a member on a copayment product to pay the entire billed charge up front, and should not bill the member for amounts above the allowable charge.
08If any amount above the allowable charge was collected, refund that amount to the member.
09Include a copy of the primary carrier's EOB when billing Blue Cross as the secondary payor, and include the primary carrier's EOB when refunding overpaid secondary claims.
10Generally a member cannot be billed for services determined not medically necessary, experimental or investigational, unless the member receives advance written notice that identifies the services, states they may be deemed not medically necessary or experimental or investigational, provides a cost estimate, and the member agrees in writing in advance to assume financial responsibility.
11Generic or all-encompassing notifications do not meet this requirement.
12Submit requested medical records for HEDIS chart reviews in a timely manner (5-7 business days) and as scheduled with the vendor, because failure to timely provide records may result in limitation of payment or no payment.
13Obtain a preservice review for spine surgery, interventional spine pain management and radiation therapy for oncology through the AIM ProviderPortal; beginning January 1, 2018 and as policies renew, authorization penalties apply for no preservice authorization.
14For short-acting opioids, prior authorization is required for fills longer than a 7-day supply and for fills longer than a cumulative 21-day supply within 60 days.
15For long-acting opioids, prior authorization is required for new users.
16Check current applicability of these historical rules before acting.
Codes mentioned
90756
Original notice
Network News - 4th Quarter 2017
providers.lablue.com · Always check the source before changing claims.
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