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

February 21, 2024

Additions to Independent Lab Network

Effective February 1, 2024, LabCorp is in-network with Blue Cross VT. The contract with LabCorp includes the following laboratories:

The complete listing of Independent in-network laboratories is located here.


February 14, 2024

Update to Telemedicine CPP_03

The policy has been updated retroactively to January 1, 2024, to allow G2211 when Blue Cross Vt is the primary carrier. It was previously only allowed if Medicare was the primary carrier and Blue Cross VT was secondary. The updated policy has been posted here


February 12, 2024

Providers who have Opted out of Medicare

Great news! You no longer need to submit a copy of your Medicare opt out letter with every claim for members who have Medicare as primary and Blue Cross VT product as secondary. Effective immediately, submit a modifier -GY on each service line. This will allow the claim to process through without looking for a copy of the opt out letter to Explanation of Medicare Processing.

The provider handbook will be updated with this information in the March 2024 release.

If you have any questions, please outreach to your provider relations consultant.


February 5, 2024

HEDIS Record Data Collection

Starts in February. Again this year, we are partnering with Change Healthcare. If you are contacted by Change Healthcare for record retrieval, please respond to them in a timely manner.


February 1, 2024

Preventive Care Guide Update  

The preventive guides is updated as of February 1, 2024 for the following:

View the updated preventive guide


February 1, 2024

1099’s

1099’s were mailed out on January 31, 2024. Please allow 14 business days for USPs delivery. If you do not receive your 1099 by February 20, 2024, please contact your provider relations consultant. Please note: 1099’s are not available on the provider resource center.


January 31, 2024

Medical Policy Updates for April 1, 2024

View more details about the updates here.


January 24, 2024

ClaimsXten-Select™ for April 1, 2024

The ClaimsXten-Select™ upgrade is scheduled for Monday, April 1, 2024.

Review full details


January 24, 2024

MD Rx for April 1, 2024

We are conducting an analysis of our community fee schedules for HCPCs services. 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. We refer to these as MD Rx.

If it is deemed that updates are needed to the community fee schedule, the updated fee(s) will take effect for dates of service April 1, 2024.

Review full details


January 18, 2024

The Preventive Care Guide has been Updated

An overview of the January 1, 2024 updates can be found on pages 50 & 51 of the Preventive Care Guide, located here: https://www.bluecrossvt.org/documents/preventive-care-guide


January 18, 2024

Webinar on Modifiers -25 and -59

Thanks to all who participated in the webinar on December 13, 2023. A lot of great information was shared. A recording of the webinar, the slide deck and the questions & answers are available on the Coding tab on our Provider Forms and Resources Page: https://www.bluecrossvt.org/providers/provider-forms-resources .

Thank you to the Vermont Medical Society for collaborating with us to bring you this webinar.


December 21, 2023

Updated Provider Handbook

The Provider Handbook has been updated to include details we have already done notices on. Updates are in red font.

View the updated Provider Manual


December 20, 2023

Hearing Benefits for 2024

Review full details


December 20, 2023

Contraceptive Counseling and Management

As a reminder, if you are doing contraceptive counseling or contraceptive management with a patient, the diagnosis in the first position needs to align with those eligible diagnoses in our preventive grid located under Preventive Gynecologic and Wellness Exam for Contraceptive Management. Contraceptive encounters are eligible for first dollar coverage (without member liabilities) when billed using one of the diagnoses listed in our Preventive Grid.


December 18, 2024

MRI Prior Approvals

Effective February 1, 2024, MRI services performed by New Hampshire of Vermont Open MRI do not require prior approval for Blue Cross VT and NEHP/ABNE members.

Review full details here.


December 18, 2023

Mental Health and Substance Use Disorder Services Prior Approval

We are pleased to announce that our trial programs for the removal of prior approval for Mental Health and Substance Use Disorder (MHSUD) services are now permanent.

Review full details here.


December 18, 2023

Acupuncture Payment Policy (CPP_02)

The Acupuncture Payment Policy has been updated effective January 1, 2024. The updates are the result of additions and revisions of CPT® effective January 1, 2024.

The updated policy has been posted here.


December 14, 2023

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

View our recent correspondence to learn about new and revised codes


December 14, 2023

Telemedicine Payment Policy (CPP_03)

The Telemedicine Payment Policy has been updated effective January 1, 2024. The updates are the result of additions and revisions of CPT® and HCPCS effective January 1, 2024. Below is an overview of the updates:

  • Added codes G0466, G0467, G0469 and G0470
  • Added instructions to the coding table for G2010
  • Revised the code description for 99202-99205, 99211-99215, 99231-99233 and 99308

The update policy has been posted here.


December 14, 2023

Community Durable Medical Equipment Fee Schedule

Will have adjustments made for dates of service March 1, 2024 forward.

Review full details here.


December 14, 2023

Tired of Waiting on Checks?

This time of year, post offices have an increased volume of mail to deliver, which can cause delays. In addition, some are still not fully recovered from the flooding this summer. There are no delays in Electronic Fund Transfer (EFT). Payments are posted to your bank on Friday of each week. We encourage you to sign up for EFT. It is free and signing up has four easy steps:

  • Step 1: Go to the Zelis enrollment hub at https://vt8004.payeehub.org to provide your initial registration information, including demographic and contact information about your practice. A registration guide is available on the site.
  • Step 2: Zelis will issue a secure registration code via email upon receipt of your initial registration. Issuance of the registration code may take several days.
  • Step 3: Return to the Zelis enrollment hub at https://vt8004.payeehub.org, enter the registration code and complete the additional requested enrollment steps.
  • Step 4: Zelis will then verify the enrollment information you submitted. Completion of the enrollment verification process may take 14-21 days. You will be notified via email about the successful enrollment that will lead to issuance of electronic payments from Blue Cross VT.

If you have any questions about electronic payment enrollment, please call the Zelis Customer Care team at (877) 882-0384. Business hours are Monday through Friday 9 a.m. - 8 p.m.

If you have questions about EFT, you can visit our website: https://www.bluecrossvt.org/providers/provider-electronic-payment. If you still have questions, feel free to outreach to your provider relations consultant. If you are not sure who that is, please call (888) 449-0443 option 1, and you will be directed.


December 13, 2023

Medical Record Retrieval Projects for the ACA and MA populations

We have partnered with Reveleer for two concurrent projects:

  • 2023 Risk Coding Initiative Project - for the medical record retrieval of 2023 claims for our ACA population. This is not different from what has happened in the past years.
  • 2022 MA Outreach - for the medical record retrieval of the 2022 claims for our VBA Population.

If you receive a request from Reveleer for either of the above projects, and you may receive a request for both, please be sure to respond to each project promptly following the instructions provided. These processes are 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 risk coding or these projects, please contact the risk adjustment department at riskadjustment@bcbsvt.com or (802) 371-3540.


December 12, 2023

Date(s) of Service on Claims

As a reminder, we do not allow for advanced billing of services for Blue Cross VT primary claims. The date(s) of service reported on a claim cannot exceed the submission date.

Our claim system was not consistently applying this requirement. However, starting in the first quarter of 2024, the logic is updated, and claims will deny accordingly.


December 5, 2023

Disposable Breast Milk Storage Bags:

Effective January 1, 2024, the temporary HCPCS code for breast milk storage bags, K1005 has been deleted. It has been replaced with a new permanent code A4287.

Code A4287 description: Disposable collection and storage bag for breast milk any size, any type.

The change in the code does not have any impact to members benefits, they will be the same.

The reimbursement will remain the same as well.

Claims must be submitted with the correct code for when the breast milk storage bags were supplied.


December 1, 2023

CMS recognition of LMFTs and LCMHC

If you are a Group Practice that has a Medicare Advantage contract amendment with Licensed Marriage and Family Therapist and/or Licensed Clinical Mental Health Counselors, they will need to be enrolled once approved by CMS.  

Review full details

Please note, if you are a private practitioner or a group practice that does not yet have a Medicare Advantage contract amendment, we will be posting your details shortly.


December 1, 2023

Updated Credentialing Policies

Our Professional and Facility Credentialing Policies have been updated and are posted to the Provider Policies page under Enrollment and Credentialing Policies.


December 1, 2023

Update to Telephone Payment Policy (CPP_24)

We have updated the policy modifier table under the Policy & Billing Documentation Guidelines to add modifier -V3.  In addition, attachment 1 Instruction column advises on expected modifier usage. The changes are effective January 1, 2024.

View the updated policy.


November 16, 2023

Final update on Issues with Radiology Prior Approvals from 09.22.23–10.16.23

View more details.


November 15, 2023

Updated – Medical Policy Updates for December 1, 2023

View more details about the updates.


November 14, 2023

Preferred Drugs for Medical Benefits

Starting January 1, 2024, we are adding/changing preferred drugs in the medical benefit for certain drug categories.

Review full details here.


November 14, 2023

ClaimsXten-Select™ for February 1, 2024

The ClaimsXten-Select™ upgrade is scheduled for Thursday, February 1, 2024.

Review full details here.


November 8, 2023

New - Coding Tip Sheets 

We have developed and posted coding tip sheets for the most common coding issues/questions providers have asked. These tips sheets include:  

  • Column Two Procedure with Column One Procedure Code
  • Evaluation & Management with Chiropractic Manipulation Therapy
  • Evaluation & Management with Modifier -25 and Surgical Procedure on the Same Day
  • Evaluation & Management with Osteopathic Manipulation Treatment
  • Modifier -25
  • Modifier -59 (including XE, XS, XP and XU) 
  • Physical Medicine Codes with Chiropractic Manipulative Treatment (97112, 97124, 97140 with 98940-98942)
  • Physical Therapy Re-Evaluation

They are located on our provider website, under Provider Forms and Resources webpage in the Coding Tip Sheets section.


November 8, 2023

Updates to Telemedicine (CPP_03) and Telephone Only (CPP_24) Payment Policies

Both policies were updated to include already existing policy details related to a providers location and Blue Cross VT contract.

The updated policies are under the Provider Payment Policies on our Provider Policies webpage.


November 7, 2023

Prior Authorization Tool User Guides

The Prior Authorization Portal User Guides have been relocated to the Prior Approval webpage, under Prior Authorization Portal Guides accordion.

They are also posted in the Provider Resource Center under Prior Approval/Pre-Notification/Prior Auth link.

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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