As of 03/01/2021 there will be 7 new codes that will be added to the Commercial Plans Prior Authorization List.
Below are the codes:
Requesting an Authorization: Providers can request an authorization 2 ways-
New provider Network Name is Blue High-Performance Network.
Effective 01/01/2021 there will be new Blue HPN Network/Plans, available for large and small group employers plans, with the existing Connection network as the New York HPN entry.
According to Empire BCBS (Anthem)-Blue HPN is a NATIONAL NETWORK that will be available across US in 50 cities. It consists of many local networks that then are connected to the national chassis to form a national Blue HPN.
For NY Providers- Blue HPN plans will be EPO plans or HSA plans with an EPO network. Under these plans, out of network benefits are limited to emergency or urgent care.
If you, as a NY provider, do not know if you accept these plans, please contact your Empire Provider Relations Representative.*
The provider participation in Blue HPN network/plans will be available Empire BCBS directory as of 01/01/2021.
*Note: if you are unable to reach your empire provider relations representative, you can also check your participation when you are checking the benefits for the patient. However, if that is not an option, I would suggest that the providers would hold off on seeing new patients with those type of plans, until they can verify their participation in the Empire Directory. This will prevent a lot of unnecessary denials.
#anthem #bcbs #connectionnetwork #NYHPN
Update: Oxford/UHC/ NYSHIP (Empire Plan) and 1199 DO NOT PAY FOR THIS CODE.
As of 09/08/20-there is a new CPT code 99072 became available for PPE.
Definition 99072:
Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease.
Coding Guidelines:
Code 99072 is to be reported only once per in-person patient encounter per provider identification number, regardless of the number of services rendered at that encounter.
Code 99072 is designed to capture the following practice expense factors:
HOWEVER, as of 09/09/2020 as per NY STATE DOH there was a letter sent out to providers from various insurance payers: Anthem BCBS (Empire), MVP, EmblemHealth warned providers not to collect any copay, coinsurance for PPE.
IF the patient was charged for PPE, the provider has to refund they should issue a refund to members immediately and contact your Empire Network Services representative to report the following:
Below are the links to the announcements that were went to the NY providers from above mentioned insurance payers/ NY DFS Letter :
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