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 Insurance, Updates

Empire BCBS (an Anthem Company)- New Provider Network for 2020

Episode 2.

Starting on 01/01/2020 Empire BlueCross BlueShield HealthPlus (Empire HealthPlus) will be introducing a new Network.

This network will replace the Pathway Enhanced Network. The name of this new network will be “Individual Network”. It will be used for commercial individual products that are available both on and off the healthcare exchanges.

Members that have benefits under this network will receive cards that say “Individual Network” on the bottom right side. (Example of the card is enclosed)

anthemcardexample

There Prefixes used will be: VJD or VFG

*Please take note that this is an HMO network. These members do not have out of network benefits.