Provider News & Updates

November 1, 2026

Thanksgiving Holiday Observance

We will be closed on Thursday, November 26 and Friday, November 27, in observance of the Thanksgiving Holiday. We will reopen for normal business hours on Monday, November 30, 2026. 

October 30, 2026

CMO Corner: Introducing Chief Network Strategy Officer

I’m excited to share a brief introduction to Brennan Holmes, who recently joined Blue Cross and Blue Shield of Vermont (Blue Cross VT) as our Chief Network Strategy Officer.

Brennan comes to us from Beth Israel Lahey Health Performance Network, where he served as Executive Director of Payer Strategy and worked closely with our President & CEO, Beth Roberts. Having worked alongside him, Beth has seen firsthand his commitment to developing data-driven contracting strategies and collaborating with providers to make healthcare more affordable.

With two decades of healthcare leadership experience, Brennan will oversee contracting strategy, network management, provider relations, and risk adjustment. I know he especially looks forward to working with our provider community.  

Regards,
Dr. Tom Weigel
Chief Medical Officer

October 30, 2026

October Community Letter

On October 6, our President & CEO, Beth Roberts, sent a letter to community members sharing how Blue Cross VT is investing in healthy communities and working to make healthcare more affordable

Read the full letter

October 30, 2026

Claims Tips and Tricks for All Providers

Do you know we have tips to help you manage your accounts receivable? This includes general claim submission, Medicare crossover claims, claims appeals, FEP claims, and more. Check them out!

Get the tips

October 30, 2026

Important Updates to Policies, Codes, Provider Handbook, and Preventive Guide

Starting January 1, 2027, updates to our policies, provider handbook, codes, and preventive guide go into effect. Please take a moment to review these updates, as they may impact your practice and patients.

Medical Policy Changes
Payment Policy Changes
Code Processing Changes
Provider Handbook Updates

Preventive Guide Update: Prediabetes Intervention

Blue Cross VT has added ICD-10-CM code R73.03 (prediabetes) as an eligible diagnosis in conjunction with eligible intervention procedure codes to align with the United States Preventive Services Task Force’s (USPSTF) recommendation to screen overweight or obese adults aged 35 to 70 for zero-cost share.

Please refer to the Preventive Guide for additional information. This change will be retroactive to August 1, 2026. You should see adjustments on your provider voucher in the next 30 days.

Maternity Care Payment Policy Update

The American Medical Association has adopted substantial changes that will replace the current global maternity care and delivery codes with new and revised CPT® codes.

Our updated maternity care payment policy will go into effect starting January 1, 2027.

View the Notification

Claims Editing Payment Policy Update

Our updated claims editing payment policy will go into effect starting January 1, 2027.

View the Notification

October 30, 2026

Vermont Blue Advantage (VBA) Operations Ending  

Claims for services that were rendered to VBA members in 2025 must be submitted to VBA prior to December 31, 2026. No claims, claims adjustments, or appeals for VBA members will be accepted or processed after December 31, 2026.

• Claims, including corrected claims, and medical records can be faxed to (800) 479-8973.
• Claim denial appeals can be faxed to (800) 479-8938.
• For mailing address and other non-medical claim submission information, please refer to the Contact Us page or contact VBA Provider Services at (844) 839-5122, Monday through Friday, 8 a.m. to 5 p.m., EST.. The VBA Provider Services line will be open through December 31, 2026.  

The VBA provider portal will be accessible through January 31, 2027. Please download any Explanation of Payments (EOPs) or other materials you may want from the portal before that date.

October 30, 2026

Risk Coding Project: Outreach Starts Soon

Our partner, Reveleer, will begin outreach in November to retrieve 2026 medical records for claims identified in the Risk Coding Project. If they reach out to you, please be sure to respond promptly and follow the instructions they provide. If you have any questions, please contact a member of the Risk Adjustment Department by email at RiskAdjustment@bcbsvt.com or phone at (802) 371-3540.

October 30, 2026

Pharmacy Updates

Pharmacy Benefit January 1, 2027 Changes

Formulary changes take effect each year on January 1 and July 1. Patients and providers received personalized letters in October outlining any changes. Updated formulary lookup tools and PDFs will also be available on our website beginning January 1, 2027.

• For most drugs where there is an available generic, the generic will be preferred, and the brand will be excluded. Examples include: Atrovent HFA, Farxiga, Januvia, Janumet, Lumigan, Motegrity, Revlimid, Saxenda, and Viibryd.
• Quantity Limits will be added for diabetic test strips: 100 strips per 30 days without insulin use; or 300 strips per 30 days with insulin use.
• New prior authorization and formulary override exception requests associated with these drugs must be submitted on or after January 1, 2027.

See the full list

Medical Drug Changes for January 1, 2027

Infliximab (Remicade) product changes:

• Avsola (Q5121) and Renflexis (Q5104) will remain preferred and will not require prior authorization.
• Avsola and Renflexis are biosimilars of infliximab (Remicade), so patients can switch to these if previously prescribed a different infliximab product.
• Inflectra (Q5103) will become nonpreferred and will require prior authorization starting 1/1/27. Blue Cross VT members taking Inflectra have received a letter notifying them of this change and guidance on next steps to ensure no gap in treatment.

October 30, 2026

Reminder: Recredentialing with Verisys 

Verisys (a national credentials verification organization) is responsible for primary source verification of our credentialing and re-credentialing process.  During this process, they may reach out to you for additional information. If so, please make sure you respond immediately. Failure to do so will jeopardize your network status with us.

To ensure your Council for Affordable Quality Healthcare (CAQH) information is current and attested to every quarter, you can review your CAQH ProView™ account at proview.caqh.org. This tool provides you with the ability to complete your application, control and update your data stored in the database, and make the data electronically available to participating insurance carriers.  

Here are some things you will want to review in CAQH:

• Current copies of malpractice insurance, current licensure, DEA, etc., are successfully uploaded.
• Provider status is at Re-Attestation
• Blue Cross VT is authorized to receive your provider data from CAQH

Are you unable to access CAQH or have questions regarding the primary source verification process? Contact Verisys Customer Service at (855) 743-6161 Monday through Friday from 8:00 a.m. to 8:00 p.m. EST.

Note: The information above is informational – no action is required.

October 30, 2026

Enhanced Community Primary Care (ECPC) Reminder

Are you submitting CPT category II codes for Controlling Blood Pressure and Diabetes- Glycemic Status? If you are not yet submitting these on claims, we encourage you to do so now. Meeting the Metric Threshold for these two metrics will increase your overall per member per month payout.

ECPC Quality and Utilization Metric Table

October 30, 2026

Attention Dental Practices 

The Federal Employee Program Maximum Allowable Charges (MAC) for 2027 and 2028 is now available. If you would like a copy, please contact provider relations at providerrelations@bcbsvt.com or (888) 449-0443 option1.

October, 30 2026

Federal Employee Program (FEP) 2027 Prior Authorizations

The full list of changes to FEP's prior authorization lists for 2027 have not been released. FEP has announced that beginning January 1, 2027, CT, MRI, and PET will require prior authorization for all FEP plans.

Next month, we will share additional updates regarding prior authorization for 2027.

September 30, 2026

CMO Corner: Important Changes to Global Maternity Care Coding and Billing

The American Medical Association has adopted substantial revisions that will replace the current global maternity care and delivery codes with new CPT® codes.

Starting January 1, 2027, these code changes affect how maternity care services are reported and include the introduction of new labor management codes and the deletion of several longstanding maternity package codes.  

We are here to help support you and your practice with these changes and will continue to keep you informed as we learn more and further update our claims processing system, payment policies, and provider handbook.

Read more

September 30, 2026

Important Updates to Policies, Provider Handbook, and Preventive Guide

Starting December 1, 2026, updates to our medical and payment policies, provider handbook, and preventive guide go into effect. Please take a moment to review these updates, as they may impact your practice and patients.

Payment Policy Changes
Preventive Guide Updates
Medical Policy Changes
Provider Handbook Updates

September 30, 2026

Adaptive Maintenance Reminder

Our quarterly adaptive maintenance email was sent on September 15 with new and revised codes effective October 1, 2026. Check your email or visit our Provider News & Updates webpage to view the notification.

September 30, 2026

Pharmacy Updates

Stay informed to ensure your patients' prescriptions are appropriate and timely.

New Generics and Formulary Additions for October 1, 2026

• New Tier 1 generics are available for Xeljanz and Xeljanz XR
• Breztri aerosphere inhaler is added as a Tier 2 medication with a quantity limit, but no prior authorization

January 1, 2027 Formulary Changes

Formulary changes occur on January 1 and July 1 of each year. Patients and providers will receive individualized letters in October about any changes.

• For most drugs where there is an available generic, this will be preferred, and the brand will be excluded. Examples include: Atrovent HFA, Farxiga, Januvia, Janumet, Lumigan, Motegrity, Revlimid, Saxenda, and Viibryd.
• Quantity limits will be added for diabetic test strips: 100 strips per 30 days without insulin use; or 300 strips per 30 days with insulin use.

See the full list

Medical Drug Changes for January 1, 2027

Changes for Infliximab (Remicade) products:

• Avsola (Q5121) will remain preferred and will not require prior authorization
• Renflexis (Q5104) will be preferred and will not require prior authorization
• Inflectra (Q5103) will become nonpreferred and will require prior authorization.
  • Note: Blue Cross and Blue Shield of Vermont (Blue Cross VT) members taking Inflectra will receive a letter notifying them of this change and providing them with guidance on next steps to ensure no gap in treatment.

Avsola and Renflexis are biosimilars of infliximab (Remicade), so patients can switch to these if previously prescribed a different infliximab product.

Questions? Reach out to our Clinical Pharmacist, Amy Stoll, PharmD at stolla@bcbsvt.com or (802) 371-3657 to discuss drug coverage or clinical questions.

September 30, 2026

Free Cultural Health Training for Your Practice 

The U.S. Department of Health and Human Services, Office of Minority Health has free virtual continuing education programs available to help healthcare professionals provide more inclusive care.

Here are a few benefits of participating in cultural health training:

• See Better Patient Outcomes: Culturally informed care increases treatment success and patient satisfaction.
• Reduce Disparities and Risk: Unconscious bias training builds providers’ capacity to address cultural barriers to health and improves access to care for people who speak or sign languages other than English.
• Meet Standards: Many regional networks and insurance panels require ongoing equity education.

Learn more

September 30, 2026

Fourth Quarter 2026 Provider Directory Validation 

The fourth quarter Provider Directory Validation will be released in early October.

Providers and practices who do not complete the validation within the specified timeframe (as defined in the directory validation email) will be removed from our online directory.

Instructions to complete the process are located on the Enrollment and Credentialing area of our website.

If you have questions, please call (802) 371-3745, option 2 or email CAA@bcbsvt.com. 

September 30, 2026

Keep Your Contact Information Current

We frequently send important communications (like this newsletter!) by email, so it is critical to make sure that we have your current email address on file.

If you need to make a change, you can reach out to providerfiles@bcbsvt.com with your new contact information and billing NPI number.

September 30, 2026

In-Network Laboratories

As outlined in our Use of Non-Network Providers Payment Policy, Blue Cross VT contracted providers are expected to direct members to use in-network providers when arranging care.

If you do not have in-office lab draw services, you can use the independent in-network lab draw stations listed below. Independent labs are lower cost alternatives that can offer extended hours and patient convenience. See a full list of Independent Laboratories contracted with Blue Cross VT.

September 30, 2026

Vermont Blue Advantage (VBA) Operations Ending

Claims for services rendered to VBA members in 2025 must be submitted prior to December 31, 2026.

• Claims, including corrected claims, and medical records can be faxed to (800) 479-8973.
• Claim denial appeals can be faxed to (800) 479-8938.

For VBA’s mailing address and other non-medical claim submission information, please refer to the Contact Us page or contact VBA Provider Services at (844) 839-5122, Monday through Friday, 8 a.m. to 5 p.m., EST., with any questions. The VBA Provider Services line will be open through December 31, 2026.

The VBA provider portal will be accessible through January 31, 2027. We recommend that you download Explanation of Payments (EOPs) or any other documents you may need from the portal before then.

September 4, 2026

Carelon Routine Maintenance

Our radiology management partner, Carelon’s prior authorization tool will be unavailable for the dates and times below.

• From 9:00 p.m. (CST) on Friday, September 11, 2026, through 6:00 p.m. (CST) on Sunday, September 13, 2026
• From 9:00 p.m. (CST) on Friday, October 9, 2026, through 6:00 p.m. (CST) on Sunday, October 11, 2026

If you have an urgent prior authorization request during this time, please contact the Blue Cross VT Care Management staff at (800) 922-8778.

September 4, 2026

Prenatal Care and New Obstetric Billing Codes Seminar

As you are preparing for the implementation of the new obstetric billing codes, we wanted to share this learning opportunity with you. 

On September 16, Dr. Alex Peahl and a panel of clinical leaders will present "Implementing Tailored Prenatal Care and New Obstetric Billing Codes". The webinar will explore the recently released tailored prenatal care clinical guidance, real-world implementation experiences, and the implications of the upcoming 2027 transition to unbundled obstetric payment codes.

• Implementing Tailored Prenatal Care and New Obstetric Billing Codes
• Date: September 16, 2026
• Time: 2:00 p.m. ET

Sign up for the webinar

We encourage all physicians and practitioners, coders, and billing professionals to evaluate the potential impact to clinical documentation and claims workflows to ensure readiness for these significant coding changes.

Here are resources on the coding changes:

• AMA CPT^® 2027 Maternity Care Services Code Changes 
• AMA CPT^® 2027 Maternity Care Services Code Guidelines
• AMA FAQs: CPT^® 2027 Maternity Care Services Code Changes

September 1, 2026

CMO Corner: VT Affordable Care

At Blue Cross and Blue Shield of Vermont (Blue Cross VT), we’re committed to helping educate Vermonters on how to navigate the healthcare affordability challenges in our state. Like last year, we are collaborating with Northwestern Medical Center, Green Mountain Surgery Center, Vermont OPEN Imaging, and Vermont Diagnostic Imaging to help empower our community to make more informed decisions about their care.

The new VT Affordable Care website features resources like cost comparison tools, local viewpoints on affordable care, prescription drug savings opportunities, questions patients can ask at appointments, and more.

The overall goal is to provide a more complete picture of how prices vary by service and facility. For example, showing that while some hospitals may be among the most affordable for certain services, they may cost more for others.

Making high-quality affordable healthcare a reality requires collaboration across the entire healthcare system, and we’re committed to being a strong partner to Vermont’s providers. If you have questions or feedback, please don’t hesitate to reach out.

Regards,
Dr. Tom Weigel
Chief Medical Officer

September 1, 2026

Only 30 Days Left - Don't Miss Your Payments!

As of October 1, 2026, we will no longer issue paper checks. Sign up for Electronic Fund Transfer ( EFT ) before October 1, 2026, to ensure you receive payments.

Sign Up Now
Get more information on how to enroll

September 1, 2026

Important Updates to Policies, Provider Handbook, Preventive Guide, and Codes

Starting November 1, 2026, updates to our medical policies, provider handbook, preventive guide, and codes go into effect. Please take a moment to review all of these updates, as they may impact your practice and patients.

Code Maintenance Changes
Provider Handbook Updates
Preventive Guide Updates
Medical Policy Changes

September 1, 2026

Artificial Intelligence (AI) Inquiries

Blue Cross VT will not respond to AI generated, automated, or non-live inquiries or calls made to any area of the company. If your office or a third-party vendor is using AI, please make sure it does not contact us. Suspected AI calls will be disconnected. This decision has been made to protect our data and our members.

The Provider Resource Center (PRC) makes it easy to find the information you need, whenever you need it. If you need assistance, we're here to help. You, or a member of your practice, can reach out to the provider relations team by email at providerrelations@bcbsvt.com or by phone at (888) 449-0443, option 1.

September 1, 2026

Granting Access for Third-Party Billers

Third-party billers or vendors are defined as those entities/persons who are:

• Not physically located at a provider or group office
• Not direct employees of the provider or group
• Those submitting claims or following up on accounts on behalf of the provider or group and have a business associate relationship with the provider or group.

Please note that the provider or group should be prepared to provide proof of a business associate relationship with the biller/vendor upon request.

For information to be released, the provider or group must authorize third-party billers or vendors with us.

Additional details, including the steps needed for granting access, are located in our Provider Handbook, in Section 6.1 General Claim Information.

September 1, 2026

Contraceptive Counseling Reminder

If you are working with a patient on contraceptive counseling or contraceptive management, the diagnosis in the first position needs to align with those eligible diagnoses in our preventive guide, under Preventive Gynecologic and Wellness Exam for Contraceptive Management. When you bill using one of the diagnoses listed in the preventive guide, the services are eligible for coverage without member cost-share.

September 1, 2026

National Drug Code (NDC) Notice: Live on October 30

NDC billing rules will be systematically enforced for claims processed on or after October 30, 2026. This may mean that claims previously accepted will be denied for failure to follow NDC billing rules.

As a reminder, billing requirements for NDC, Unit of Measure, and Quantity have been in place since September 1, 2016—the only change will be in the enforcement. You can learn more about NDC billing rules on our website, where you can also find an FAQ to help answer any of your questions during this process.

We encourage you to review your claim submissions for these services and make sure they are correct and compliant now. Doing so will ensure you will not be impacted by denials going forward.

September 1, 2026

Vermont Blue Advantage (VBA) Claims Reminder

Claims for services rendered to VBA members in 2025 must be submitted by December 31, 2026.

• Claims, including corrected claims, and medical records can be faxed to (800) 479-8973.
• Claim denial appeals can be faxed to (800) 479-8938.

For VBA’s mailing address and other non-medical claim submission information, please refer to the Contact Us page or contact VBA Provider Services at (844) 839-5122, Monday through Friday, 8 a.m. to 5 p.m., EST., with any questions.

September 1, 2026

Timely Filing Reminder

All claims must be filed within 180 days of the date of service or they will be denied.

Providers can verify and review the receipt and status of a claim in the Provider Resource Center, or by contacting the appropriate customer service team. If contacting a customer service team, you must wait at least 30 days from the submission date before requesting a status.

If you would like assistance or instructions on using the Provider Resource Center, please contact the Provider Relations Team at (888) 449-0443 option 1.                

Read more

September 1, 2026

Adaptive Maintenance for October 1, 2026

In a few weeks, we will be sharing a special newsletter that will provide details on the implementation of the new and revised codes for October 1, 2026.

September 1, 2026

Documentation and Coding Training Series

Provider groups have asked, and we have delivered! Check out our series of short documentation and coding video trainings. These resources are based on industry standard best practice guidelines and are designed to support coders, billers, and providers.

Monthly Newsletters

• May 2026
• June 2026
• July 2026
• August 2026
• September 2026
• October 2026

Adaptive Maintenance Newsletters

• December 2025
• March 2026
• June 2026
• September 2026

Our monthly provider e-newsletter is our primary source for all notices and updates. It replaces the individual notices you used to receive. If there are staff in your office that would like to be on our distribution list, please contact Provider Relations at providerrelations@bcbsvt.com. 
 

• 2026 Provider Required Annual Notice