Posted in BCBS Empire NY, Training, Updates

BCBS NY Medicaid: New Policy-Pass-through and Outside Laboratory billing

This reimbursement policy applies to Empire BCBS Health Plus members. The new reimbursement policy will become effective for DOS on 10/01/2021 and thereafter.


Empire BlueCross BlueShield HealthPlus does not allow pass-through billing for lab services. Claims appended with Modifier 90 and an office place of service will be denied unless provider, state, federal or CMS contracts and/or requirements indicate otherwise.


Reimbursement:

Empire BCBS HealthPlus will reimburse 100% of the applicable fee schedule or contracted/negotiated rate to the diagnostic laboratory that is performing the test.


Coding: Modifier 90-definition

Modifier 90 is used when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified healthcare professional. The procedure may be identified by adding Modifier 90 to the usual procedure number.

To read the complete reimbursement policy, please click here.


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Posted in BCBS Empire NY, Training, Updates

BCBS NY: Reimbursement Policies Updates for 2021

1.Reimbursement Policy: Consultations (Professional)

Effective 10/31/2021- Empire BCBS policy “Documentation and Reporting Guidelines for Consultations” policy will be renamed as “Consultations” Please remember that this policy will be updated to align with CMS guidance- DOES NOT ALLOW reimbursement for inpatient (99251-99255) or outpatient (99241-99245) consultation codes and requires providers to bill the appropriate office visit Evaluation and Management (E&M) code for consultation services

To read this full reimbursement policy, please click here.


2. NEW Reimbursement Policy (facility): Non-patient Laboratory Services

Effective 10/01/2021- Empire BCBS will implement a new reimbursement policy- Non-Patient Laboratory Services. This policy states that Empire does not allow reimbursement for non-patient laboratory services when reported on a UB-04 with bill type 014X unless provider, state, federal or CMS and/or requirements indicate otherwise

To read this full reimbursement policy, please click here.


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Posted in Updates

Empire BCBS (for NY providers)- reminder of address change for FEP claims and correspondence.

Empire BCBS FEP (Federal Employee program) no longer uses the following address to submit the claims or correspondence.  

PO Box 3876

Church Street Station

New York, New York 10008-3876

The new Correct Address for submitting paper claims and correspondence is:

Federal Employee Program (FEP) Claims and Correspondence

P.O. Box 105557

Atlanta, GA 30348-5557

The claims sent to the OLD address will NO LONGER BE FORWARDED TO THE NEW ADDRESS!