Summary
Effective January 1, 2018, all BlueCHiP plans require primary care providers (PCPs) to generate web-based referrals to specialists. This applies to BlueCHiP Commercial and all individual BlueCHiP for Medicare products, and Group BlueCHiP for Medicare members do not require a referral. Claims filed for specialist services rendered without a web-based referral will be denied, web-based referrals are valid for up to 180 days, and PCPs can retroactively generate a web-based referral within 30 days of the specialist visit. Effective January 1, 2018, CPT 99497 or 99498 can be billed for advance care planning, and claims submitted with S0257 will deny as use alternate code.
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