Changes/Updates are effective 01-01-2023
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Starting 01/01/2023 Oxford will add and remove certain codes that require prior authorizations (commercial line of business).
According the Oxford this change helps align their processes with evidence-based clinical guidelines.
Some of the new codes that will be added are:
For a full list of new codes that will be added to the list of codes that require prior authorization, please click here.
In addition Oxford is also adding a new provider tool, the UnitedHealthcare Oxford plan Prior Authorization Requirements document, it will become available as of Dec. 1, 2022, on the Advance Notification and Clinical Submission Requirements page.
Providers are encouraged to use this tool where they will be able to find/research codes that require prior authorization as well as request an auth.
Would you like to learn more: please click here, for the Applicable Oxford Commercial policies.
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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:
PT/OT/ST services reimbursement with modifiers CO, CQ for DOS 07/01/2022 and thereafter:
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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