Posted in #Medicareadvantage, BCBS (Various States), Training, Updates

BCBS of MN: Reimbursement update (modifiers 52, CO, CQ)

Please note which type of providers will be affected by each reimbursement policy for specific modifiers and the effective date it begins.


The following reimbursement updates take effect as of July 1, 2022:

  1. Modifier 52- for services performed on 07/01/2022 and thereafter, Blue Cross will be begin reimbursing procedure codes billed with a -52 modifier at the lesser of 50% of the physician fee schedule allowance or charge submitted for the following lines of business: • Commercial• Federal Employee Program (FEP)
  2. The Reimbursement Policy, General Coding – 003 Coding Edits will be updated to reflect this change.

PT/OT/ST services reimbursement with modifiers CO, CQ for DOS 07/01/2022 and thereafter:

  1. Commercial plans-

Blue Cross will be implementing a 15% reduction in the allowed amount for services
modified with CO or CQ modifier for professional providers.

The following reimbursement Policy took affect for DOS 01/01/2022 and thereafter

1. Medicare Advantage Plans-

Blue Cross implemented a 15% reduction in the allowed amount for services modified with CO or CQ modifier for professional and facility providers to comply with requirements of the Centers for Medicare & Medicaid Services (CMS).


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Posted in #aetna, #Medicare, #Medicareadvantage, Training, Updates

Aetna Medicare Advantage: participating providers’ post-service appeals new address

Are you an Aetna Medicare Advantage participating provider and had issues with your post-service appeals? If your answer is yes, it is because as of Jan 1, 2022 there is a new address where the providers need to submit those appeals to.

There is also a NEW FORM that the provider needs to fill out.

Where to find the new form?

You can find this form, which is called the Medicare Provider Complaint and Appeal Request Form, by going to the forms for health care professionals page and scrolling to the “Dispute and appeals” drop-down menu.


The New form should be sent to the address below:

Medicare Provider Appeals PO Box 14835 Lexington, KY 40512 Fax: 1-860-900-7995


OLD ADDRESS IS NO LONGER VIABLE:

Provider Resolution Team PO Box 14020 Lexington, KY 40512 Fax: 1-800-624-0756

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Aetna and Mid Level Reimbursement EM Services update 2022

According to Aetna June 2022 provider newsletter- Aetna will NO Longer pay for the mid level staff: nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists, at 100%, if they are performing the following codes:


G0402-
Long description:
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
Short description: Initial preventive exam

G0438- Long description: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Short description: Ppps, initial visit

G0439- Long description: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Short description: Ppps, subseq visit


Note to Washington State providers: Your effective date for changes described in this article will be communicated following regulatory review.


How can you access the full policy?

Log in to Availity*** and follow these steps:

  1. Click on Payer Spaces > Aetna.
  2. In the search box, type “mid-level practitioners” and click Search.
  3. Choose “Mid-level Practitioners and Other Qualified Health Care Professionals — Resource.”

This policy applies to Aetna commercial and Medicare members.

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