Prolotherapy 8.01.10

By October 15, 2025: Billing team must (1) Update billing system to flag all prolotherapy procedure submissions as investigational/non-covered for Excellus BlueCross BlueShield plans; (2) Review member contracts to identify any exceptions that include investigational service coverage; (3) Implement denial protocol for prolotherapy claims—claims will be automatically denied under investigational services policy (reference corporate policy 11.01.03); (4) Notify providers in orthopedic, pain management, and sports medicine departments of the coverage change via encounter form updates and staff communication; (5) Update patient billing statements and explanation of benefits templates to reference investigational status; (6) Train front desk and authorization staff to inform patients that prolotherapy is non-covered and may require patient self-pay or prior verification of any plan exceptions. Failure to implement denial protocols will result in improper claim payments and potential recovery issues.