Optum Health will begin covering the VA for states essentially east and north of Texas. If youâre a provider in VA CCN Regions 1, 2, or 3 and youâre transitioning to Optum for the new CCN contract, you can still accept TriWest authorizations during any overlap period and bill for those services. Read more
California Blue Cross Claims submitted on or after October 1, 2019 will be subject to a ninety (90) day timely filing requirement, and Blue Cross will refuse payment if submitted more than ninety (90) days after the date of service. If Plan is the secondary payor, the ninety (90) day Read more
Recent claims for VA under the PC3 program We have noted recent payment denials for manual therapy 97140 and massage 97124 even with GP and 59 modifiers. It appears the VA is adopting the CCI edits and bundling both codes to CMT when done to the same region. This, of Read more
Horizon BCBSNJ previously announced plans to collaborate with American Specialty Health (ASH) to implement and administer their Chiropractic & Physical Medicine Services Program for acupuncture, chiropractic, occupational therapy, physical therapy and speech therapy, effective January 1, 2020, subject to regulatory approval by the New Jersey Department of Banking and Insurance. Read more
Please be advised the information received from ASH earlier this week relating to the transition was misquoted by ASH provider relations and that the transition to using ASH with Blue Shield of California is going forward for 2020. As more details emerge we will forward it to all our members. Read more
2020 ICD10-CM Updates 71,932 codes in ICD10-CM 2018 72,184 codes in ICD10-CM 2019 273 New Codes 21 Deleted Codes 30 revisions As occurs every October 1 there are additions and deletions to the ICD10 code set. This year is had very minor updates and changes related to chiropractic coding and Read more
We have received information from sources with direct contact with ASH representatives that stated that the contract between ASH and Blue Shield of California will not go through if there is not a high enough percentage of providers who enroll Note the benefits nor allowed amounts do not change whether Read more
The latest update for 2020 Blue Shield of California ASH Plans, directly from ASH 1. The Blue Shield PPO plans to move to ASH January 1, 2020, are as follows: ⢠Individual and Family Plans (IFP): on-exchange and mirrored. The small business group plans: on-exchange and mirrored These plans do Read more
The latest information is indicating that the visit threshold will be 5 visits whether a provider is in our out of network and allowances will be the same for in and out of network services. Patients may have lesser copays or deductibles for in-network providers. Self-funded plans under Blue Read more
Guidelines for Imaging in Low Back Pain Blue Cross and Blue Shield have made policy changes in reference to imaging for lower back pain as highlighted below. Note for chiropractic claims there is indication of no routine films in absence of trauma. I would also note red flag symptoms and Read more