Provider News & Updates

Below you will find the latest on important information that may impact your practice, as well as copies of letters and notices we have released.

News and Updates

January 31, 2023

Billing for Hearing Aids and Related Services

Find the details here.


January 31, 2023

Additions and Updates to CPP_32 Code Editing Payment Policy

Find the details of the update here.

View updated policy


January 30, 2023

AIM and Radiology Prior Approval Changes

There are three changes coming up:

  • Effective March 1, 2023, AIM Specialty Health name is changing to Carelon Medical Benefits Management.
  • Effective March 1, 2023, radiology prior approval for New England Health Plan (NEHP) and Access Blue New England (ABNE) members is through Carelon Medical Benefit Management.
  • Effective April 9, 2023, Carelon Medical Benefits Management Advanced Imaging Appropriateness Guidelines are updated.

Find the details of the changes here.


January 27, 2023

Ambulatory Cardiac Monitors Medical Policy

The policy has been revised and changes are in effect for dates of service April 1, 2023, or after.

Find the details of the update.


January 27, 2023

Viewing of Prior Approvals

There are upcoming changes to the viewability of prior approval/pre-notification requests in our Provider Resource Center (PRC) and Acuity Connect. The effective date is scheduled for Monday, February 13, 2023.

Learn about the prior approval changes.


January 26, 2023

UPDATED ALERT – Claims for members with a prefix of AMX, JXA, XXP, YFW and YWA 

In early January, we discovered claims received November 23, 2022 or after for members with the prefixes above where mis-directed to Vermont Blue Advantage (VBA) for processing.  

The issue was resolved on January 9, 2023. All claims submitted January 10, 2023 or after with the above prefixes are being directed to the Blue Cross VT BlueCard for processing.

All the impacted claims have been identified and will be processed within the next 60 days.

Please note: If you receive a denial/rejection letter from VBA, please disregard. They are behind with issuing the denial/rejection letter for claims they received from November 23, 2022 – January 8, 2023.


January 24, 2023

Updated Notice on March 1, 2023, Medical Policy Updates

In December we notified you we would be archiving the Nutritional Counseling Medical Policy effective March 1, 2023. We have found it necessary to leave the policy in effect and will not be archiving on March 1, 2023. 

All of the current requirements will remain in place.

Find the detail of updates here.


January 24, 2023

MD Rx and HIT for April 1, 2023

We are conducting an analysis of our community fee schedule for NDC and HCPCS. The focus is for the categories of administrative, miscellaneous, investigational, radiopharmaceuticals, drugs "administered other than oral method", chemotherapy drugs, select pathology, laboratory, and temporary codes.

If it is deemed that updates are needed to the community fee schedule for the following categories/codes, the updated fee(s) will take effect on April 1, 2023.

Find the details of the update here.


December 21, 2022

Billing for Newborn Claims

Find updated details on how to bill for newborn claims here.


December 21, 2022

New & Revised Codes for January 1, 2023 (Adaptive Maintenance)

Learn about new and revised codes here.


December 7, 2022

Payment Policy CPP_24 Telephone Only

The Temporary/Emergency Payment Policy has been extended to December 31, 2023.

The updated policy has been posted here.


December 7, 2022

eQuote Guide Changes

On Friday, December 9, 2022, you will experience changes in our eQuote guide. 

It has a new look and feel which includes some format changes. The Quick Links have been simplified and sub-categories remove. The sub-categories are now in each specific section.

At a high level, if your specific specialty type or setting is called out, you will want to go into that link for details. If your specialty is not called out, you will want to either use the primary care physician office care or specialist office care links. Note: for physical, occupational or speech therapy, you will use the specialist office care link.

View a summary of Quick Link changes


December 6, 2022

UPDATE: Enhanced Coding Edits

The go live date for Cotiviti, Inc. will be January 13, 2023, not December 9, 2022 as previously notified.

We are partnering with Cotiviti, Inc. to enhance our review process and coding edits for claim processing. The enhancements ensure accurate coding of services consistent with standard business practices and allows us to process claims efficiently and with accurate reimbursement.

View complete notice
Review the updated payment policy


November 30, 2022

Medical Policy Updates for February 1, 2023

Find the details of the update here.


November 22, 2022

ClaimsXten-Select™ Upgrade

The ClaimsXten-Select™ upgrade is tentatively scheduled for Wednesday, February 1, 2023. Review the full details.


November 22, 2022

Partial Hospital and/or Intensive Treatment Programs for Mental Health and Substance Use Disorder

Prior approval changes related to these services go into effect on January 1, 2023. Read the full details.


November 21, 2022

2022 Risk Coding Initiative Project

Blue Cross VT has partnered with Reveleer for the medical record retrieval of 2022 claims identified in the Risk Coding Initiative project. If you receive a request from Reveleer, please be sure to respond to them promptly following the instructions they provide. This process is similar to, but separate from, the record retrieval for the Health Effectiveness Data Information Set (HEDIS) and the Risk Adjustment Data Validation Audit (RADV).

If you have any questions about this notice, contact the provider relations team at providerrelations@bcbsvt.com or (888) 449-0443, option 1.

If you have any questions about risk coding or the project, please contact the risk adjustment department at riskadjustment@bcbsvt.com or (802) 371-3540.


November 21, 2022

Federal Employee Program (FEP) Prior Approval for 2023

There are two additions to the FEP prior approval lists effective January 1, 2023:

  • Proton Beam Therapy, Stereotactic Radiosurgery, and Stereotactic Body Radiation Therapy
  • Sperm/Egg Storage

The updated prior approval list has been posted on the Prior Approval webpage. If you have any questions related to prior approval for FEP members, please contact the FEP customer service team at (800) 328-0365.


November 21, 2022

Changes in Blue Cross VT Member Search on Provider Resource Center (PRC)

The Blue Cross VT Member Search in the Provider Resource Center now requires the patient's date of birth, in addition to the last name or Member ID number to have a successful eligibility response.

If you have any questions, please contact the Provider Relations team at providerrelations@bcbsvt.com or (888) 449-0443, option 1.


November 15, 2022

2023 Holiday Observance Schedule

Click here to view the 2023 Holiday Observance Schedule


November 14, 2022

Independent Laboratory Network

Effective November 2022, our independent lab network now includes CDX Diagnostics, Inc. A comprehensive list of in-network independent laboratories has been posted here.


November 10, 2022

2023/2024 FEP Maximum Allowable Charges (MAC)

Click here to see the 2023/2024 Federal Employee Program MAC for dental services.


October 28, 2022

Medical Policy Update for January 1, 2023

Find the details of the update here.


October 18, 2022

Advanced Medicine Integration of Vermont, LLC (AMI) Implementation is delayed.

We apologize for the short notice, but our November 1, 2022 implementation of the Outcomes-Based Chiropractic Quality Initiative with Advanced Medicine Integration of Vermont, LLC is on hold. We will keep you informed of any changes.

If you have any questions, please contact provider relations by email at providerrelations@bcbsvt.com or phone at (888) 449-0443, Option1.

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Provider Handbook

Access our Provider Handbook for a comprehensive reference of resources and requirements for Blue Cross providers.

Provider Handbook
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Academic Detailing and Prescription Support for Vermont Blue Rx

Our Clinical Pharmacist, Amy Stoll, PharmD, works with our providers on specific prescription questions, drug authorizations, and patient panel projects. Amy is a board-certified ambulatory care pharmacist, certified diabetes educator and has a master's degree in public health. Learn more about the services our team can provide to you.

Provider Prescription Support