Previously, I published an article regarding Aetna Vitamin D Testing (click here to view it)
The following is the policy for Anthem BCBS:
Things to consider:
- Original date for this policy is 09/13/2017
- Policy was updated and reviewed on 08/22/2019
- Publish date: 09/25/2019
- The updated sections: discussion and general information
- Note the coding section provided
- Note the recommendation section in the policy
When the new healthcare reform took place so did the increase in more plans and networks that the payers, like BCBS started to offer to the members. Great! More people are covered and providers are able to see more patients.
However, the problem that the providers are running in is the fact that these plans have their own network. One of these networks is Pathway x Enhanced, offered by BCBS to the members that buy the insurance on exchange website.
Why is this a problem for the providers? Simple, Pathway X Enhanced network is exclusive to only certain providers that were selected for that network by the BCBS its self. But I am INN with my Local BCBS, can I join the Pathway X Enhanced network too? Unfortunately the answer to that question is NO. Why? Simply put there is a certain criteria that provider needs to meet in order to be in the Pathway X Enhanced network. You could also request the very complicated explanation from BCBS but if you have not received it in the early 2014. LOL
To avoid rejected/denied claims: train your front staff to recognize which patients have this particular coverage and double check the benefits for incoming patients BEFORE they come to the office-making sure that the incoming new patients have OON benefits and you are not incurring charges that you will have a hard time collecting.