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


August 20, 2024

Community Based Primary Care Provider Invitation to Learn More About Our Value-Based Programs

Join Blue Cross and Blue Shield of Vermont's Chief Medical Officer, Dr. Tom Weigel, to learn more about our value-based care programs available to primary care providers, as well as other initiatives that impact you and your practice.

We are launching the virtual series on September 12 from 12:00 p.m. – 1:00 p.m., with additional meeting dates and times to follow. During these meetings, Dr. Weigel will cover:

  • Blue Cross VT's Enhanced Community Primary Care (ECPC) and Vermont Blue Integrated Care (VBIC) programs and how you can participate.
  • Act 111 (formerly known as Bill H.766) – updates on our efforts and understanding the impacts to providers.
  • Understanding additional opportunities where Blue Cross VT can help you and your practice.

We hope you will join us for the first of our virtual meeting series. Pre-meeting materials, including FAQs and internal scorecards will be sent once you save your spot.

Register Now


August 16, 2024

Revised Medical Policies effective October 1, 2024

Review full details


August 16, 2024

Updated New/Revised/Archived Medical Policies effective October 1, 2024

Review full details 


August 16, 2024

Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses Medical Policy

This medical policy will not be archived as of October 1, 2024, as we previously notified you. It will remain in effect as written. Effective with date of service November 1, 2024 or after, the codes L0112, L0113 and S1040 are removed from requiring prior approval and are eligible based on medical necessity.


August 9, 2024

Use of Non-Participating Providers Payment Policy (CPP_20)

This payment policy has completed annual review, with no substantive changes. The policy has been retitled to “Use of Non-Network Providers”, moved to a new template for payments policies and the legislative reference made to Vt. Rule H-2009-03 in the section titled “Legislative and Regulatory Guidelines”.

View the policy


August 7, 2024

MD RX and Home Infusion Therapy Community Fee Schedule Review

We are conducting an analysis of our community fee schedules for National Drug Codes (NDC) and Health Care Procedure Coding System (HCPCS). If it is deemed that updates are needed to the community fee schedule, the updated fee(s) will take effect for dates of service November 1, 2024.

Review full details here.


July 31, 2024

Credentialing Policies updated for August 1, 2024

Our Facility Credentialing Policy and Practitioner Credentialing Policy have been updated effective August 1, 2024.

View the policy here.


July 26, 2024

Important Updates on Act 111 Implementation

In response to the passing of the bill H.766, now known as Act 111, Blue Cross Blue Shield of Vermont has formed cross-functional workgroups to oversee the implementation of this new law. We are working diligently to comply with Act 111. We will keep you informed through regular updates on our Act 111 section below and by emails.


July 19, 2024

ClaimsXten-Select™ upgrade for October 1, 2024

Review full details here.


July 18, 2024

Supervised Practice of Mental Health and Substance Use Trainees

The Quality Improvement Policy for Supervised Practice of Mental Health and Substance Use Trainees has been moved to a payment policy, effective August 1, 2024. There are no changes to the content and requirements of the policy.

View the policy


July 17, 2024

Robotic & Computer Assistive Devices CPP_04

Our payment policy for Robotic & Computer Assistive Devices (CPP_04) has been reviewed and updated. Below is an overview.

Policy moved to a new template. Provider Billing Guidelines and Documentation Coding Table updated to remove unit designation information (unit designation still apply), removed revenue codes, removed principle procedure codes (ICD-9-PCS), removed moderate sedation reference on code 31627 (code still remains), removed the modifier-22 specific information and link to Modifier-22 Payment Policy (CPP_)06). Updated signature to Dr. Tom Weigel.

The policy is located here.


June 26, 2024

Risk Adjustment: The Importance of Coding and Documentation

Join Blue Cross Vermont certified coders for a webinar on coding and documentation in risk adjustment. This is an excellent opportunity to refresh your knowledge and learn valuable tips on how to document and code to create the most complete and accurate clinical picture of your patients.

Event Details:

  • Date and Time: Wednesday, July 17th from 12:15 PM to 1:00 PM
  • Audience: Primary Care Provider Practices
  • Format: Online via Zoom
  • RSVP: Advance registration is required. Register now.

June 25, 2024

Code 33274 Requires Prior Approval Authorization for Dates of Service
September 1, 2024 or After.

Review full details here.


June 24, 2024

Preventive Care Guide Updates

Effective July 1, 2024, the following changes have been made tot he Preventive Care Guide: Deleted codes 0353Um, 0354U, and 0402U from all applicable sections. Added code 74263 to the Colorectal Cancer Screening section. Remove code 11980 from the Pre-Natal & Family Planning Section.

The updated Preventive Care Guide is located here.


June 24, 2024

Chiropractic Medical Policy

We have completed its annual review. During this review, we made changes to formatting and clarified that exacerbation or etiology or new injury during treatment course may support medical necessity of continued visits. The updated medical policy will be posted to the policies area of our provider website: https://www.bluecrossvt.org/providers/provider-policies under Vermont Medical Policies by Monday, July 1, 2024.


June 20, 2024

Site Visit and Medical Record Keeping Policy

An updated policy has been posted – review the policy.


June 14, 2024

New & Revised Codes for July 1, 2024 (Adaptive Maintenance)

Review full details


June 7, 2024

DME Rental to Purchase Reimbursement Payment Policy

A payment policy has been created to clarify the allowance of rental to purchase items. It can be located here.


June 6, 2024

RADV Project

We have partnered with Reveleer again this year for the medical record retrieval of 2023 claims identified in the RADV project. Outreach will begin in July. If you receive a request from Reveleer, please be sure to respond promptly following the instruction they provide.

If you have any questions on the RADV project, please contact a member of the Risk Adjustment Department by email at RiskAdjustment@bcbsvt.com or phone at (802) 371-3540.


June 4, 2024

Reminder: CAA Directory Validations

We are in the final days of the second quarter directory validation. If you have 
already completed, thank you.

If you have not:

Locate the directory validation email that was sent on April 6, 2024. The subject of the email is BlueCrossBlueShield of VT Directory Validation, and the sending email address is noreply@onbaseonline.com. Click on the link and validate or update your information. Please ensure that you complete it for every provider listed. If you cannot locate the email in your inbox, please check your spam folder for it.

If you are not able to locate the validation from April, you will be removed from the directory, and you can be relisted once you complete the July directory validation that will be released the first week of July.

Act 111 (H.766)

As we work to implement changes to our processes and policies in response to Act 111, we will keep our provider community informed. You can find key updates below – we will also be sending email communications.

We are working hard to understand the impacts and business needs of Act 111, also known as H.766. We have a group of individuals across our organization implementing the necessary changes as it relates to prior authorization, claims processing, step therapy, and provider contracting. 

As changes and updates become available, we will be keeping our providers informed through this webpage, as well as regular emails and enewsletters. Be sure to keep an eye on your email for regular updates as the work progresses throughout the remainder of 2024.

Contact us at providerrelations@bcbsvt.com to be added to our email list.

We are evaluating how to implement the requirements for the prior authorization changes. We will keep our primary care providers informed as we navigate the upcoming updates for managing prior authorizations.

Similar to prior authorizations, we are working to better understand how best to implement the requirements of Act 111. We are working to create an efficient and seamless process for claims submission and reviews.

Working with our Pharmacy Benefit Manager (PBM), we will be updating our policies and processes related to step therapy. We will provide updates to our providers on the changes once more information is available.

As we implement the requirements of Act 111, we will be sharing the ongoing updates to our policies and processes with you. Updates will be shared via email and this webpage.

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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