Tag: #BCBS

Posted in BCBS (Various States), Training, Updates

Empire BCBS Ohio: new AIM Specialty Health phone numbers

Posted on by KR2Medical Billing

If you are a physician that is accepts Empire BCBS Ohio members and requests services through AIM Specialty Health then this blog post is for you!

The following AIM Specialty Health phone numbers are effective 04/01/2022

StateAIM phone number
effective April 1, 2022
Indiana(833) 775-1952
Kentucky(833) 419-1357
Missouri(833) 305-1807
Ohio(833) 404-1678
Wisconsin(833) 342-1253

The old AIM Specialty Health Numbers will NO LONGER be active on August 15, 2022 and thereafter.

Physicians are encouraged to utilize self service via AIM is to use the ProviderPortalSM .

There physicians can:

  • Check order status and view order history
  • Print/save PDF of order summary
  • Use multiple staff members to enter/view the practice’s orders
  • Increase payment certainty
  • Reference desk training and tutorials, including clinical criteria and CPT lists

To register your practice in ProviderPortal. If you are not already registered, go to providerportal.com to register.

Find this type of contact useful? Follow my blog for more medical billing and coding guideline changes, insurance network updates, medical and reimbursement policy changes and more!

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Posted in Training, Updates

HEDIS Measure: Well-child visits in first 30 months.

Posted on by KR2Medical Billing

Bringing young children to see the primary care physician, for a well-care visit is extremely important.

These visits track:

Prevention: wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.

Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.

Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.

Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.

Description of the measure:

Describes the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months.

The rates are reported as follows:

Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.

Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.

In order to receive credit for this measure the following DX should be used:

  • ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2

The following CPT codes should be used:

  • CPT: 99381-99382, 99391-99392, 99461

The following HCPCS should be used:

  • HCPCS: G0438-G0439, S0302

Find this information useful? Follow my blog for more current medical billing and coding guideline changes, reimbursement/medical policy updates and anything else that is related to healthcare field.

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Posted in BCBS Empire NY, NY Providers, Training, Updates

Empire BCBS (NY) Changes to AIM Small Joint Surgery Guideline for 2021

Posted on by KR2Medical Billing

Reminder: as of 11/01/2020 IM Specialty Health® (AIM) began administering the AIM Musculoskeletal program to perform medical necessity reviews for certain elective surgeries of the small joints using AIM clinical guidelines for Empire BlueCross BlueShield (“Empire”) fully insured members and some ASO groups.   

Effective 03/14/2021, the following changes will be made to the Small Joint Surgery Guidelines:

  • Clarified requirements for imaging reports.
  • Removed radiographic requirement for confirmation of lesser toe deformities.
  • Ankle arthrodesis and total ankle arthroplasty added as new indications for revision of failed previous reconstructions.
  • Removed total ankle arthroplasty requirements for adjacent joint or inflammatory arthritis.
  • Clarified contraindications only apply to total ankle arthroplasty.

How to request an authorization:

  • Access AIM ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
  • Access AIM via the Availity Portal at availity.com
  • Call the AIM toll-free number at 1-877-430-2288, Monday through Friday 8:30 am – 7 pm ET.

For further questions, please contact the provider number on the back of the member ID card.