Summary
From the 2nd quarter 2017 Blue Cross and Blue Shield of Louisiana provider update. Beginning July 1, 2017, the AIM Specialty Care Shopper program applies to Preferred Care PPO and HMO Louisiana, Inc. members for MR and CT services, and AIM may contact those members about an alternative high-quality, lower-cost diagnostic imaging center. AIM will also administer medical necessity reviews of all spine surgery and pain management services for fully-insured members, effective for dates of service on and after November 1, 2017, with preservice review recommended.
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What to do
Action · 12 steps
01Already effective July 1, 2017: Diagnostic imaging providers need a completed OptiNet assessment, completed in the AIM ProviderPortal available through iLinkBlue, because without one AIM cannot determine service quality and will not offer their services to members.
02Already effective July 1, 2017: For Shopper program MR and CT services, the ordering provider enters an authorization in the AIM ProviderPortal and selects a rendering provider.
03Already effective July 1, 2017: The new HCPCS allowable charge schedule applies to claims with dates of service on and after July 1, 2017.
04Already effective September 1, 2017: The drug and drug administration allowables are updated for claims with dates of service on and after September 1, 2017.
05Already effective November 1, 2017: For fully-insured members, AIM reviews spine surgery and pain management services for medical necessity, and preservice review is recommended to establish medical necessity before the service is rendered.
06If a preservice review is not performed, the claim will reject for medical review and will need to be refiled once a determination is made.
07Append Modifier FX to all Blue Cross claims for X-rays taken on film; Blue Cross will not reduce reimbursement based on Modifier FX at this time.
08Bilateral procedures: report the code on one line with Modifier 50 and 1 in the units field.
09Postoperative complications: additional services needed because of complications that do not require additional trips to the operating room are included in the global surgery payment, and an office visit for complications during the postoperative global period is not separately reimbursed.
10CPT 99024 may be billed for informational purposes only.
11Claims must be filed with valid NPI numbers for both billing and rendering providers, the corresponding tax identification number, and the current member ID including the 3-digit alpha prefix; Social Security numbers are not accepted.
12Check current applicability of these historical rules before acting.
Codes mentioned
C9745C9746C9747Q9985Q9989C9489Q9986C9490Q9987Q9984Q998899024
Original notice
Network News - 2nd Quarter 2017
providers.lablue.com · Always check the source before changing claims.
Related changes
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