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

May 23, 2022

ClaimsXten-Select™ Upgrade

Will occur on Monday, August 1, 2022. Click here for full details.


May 23, 2022

CAMS Training in Suicide Prevention for Mental Health Providers

While we are not sponsoring this event, we wanted to let you know about this opportunity.

Click here for details on the program and how to register.


May 19, 2022

Possible Temporary CT Contrast Shortage

Click here to see AIM's clinical alert and related details.


May 20, 2022

MD Rx and Home Infusion Therapy Fee Review

We are conducting an analysis of our community fee schedules 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, the updated fee(s) will take effect on July 1, 2022.

Click here for details.


April 29, 2022

Medical Policy Updates for July 1, 2022

View the details of the update.


April 27, 2022

REMINDER: First Level Appeals for Medications

Starting May 2, 2022 OptumRx will be processing the first level appeals for drugs administered in a physician’s office or outpatient setting. Learn the complete details.


April 26, 2022

Temporary/Emergency Payment Policy CPP_31
Waiver of Cost Share for COVID-19 Acute Outpatient Treatment

Has been updated to (1) clarify billing requirements for cardiac screenings, (2) update regulatory references and (3) extend the waiver of cost sharing for outpatient treatment for services rendered through March 31, 2023. The updated policy has been posted to the Provider Policies area.


April 26, 2022

Temporary/Emergency Payment Policy CPP_30
Waiver of Cost Share for COVID-19 Related Testing Diagnosis and Inpatient Treatment

Has been updated to extend the waiver of cost sharing for inpatient treatment through admissions that began before March 31, 2023. The updated policy has been posted to the Provider Policies area.


April 8, 2022

Updated: Investigational Medical Policy

We have updated our March 2, 2022 notice on changes to the Investigational Medical Policy that will be in effect May 1, 2022. View full details.

 


April 1, 2022

Medical Policy Updates for June 1, 2022

Click here to view the details of the update.


March 30, 2022

Drugs Administered in a Providers Office (MD Rx)

We have updated this notice. View the recent document to learn the latest.


March 29, 2022

New & Revised Codes for April 1, 2022 (Adaptive Maintenance)

Learn about new and revised codes.


March 25, 2022

City of New York retirees covered by Anthem (Empire)

UPDATE March 15, 2022 - The below implementation has been delayed. We will keep you informed of any progress.

Anthem has requested we outreach to you on behalf of their members who are part of the City of New York retirees.

Effective, on a date to be determined, City of New York retirees have a Medicare Advantage Plan called NYC Medicare Advantage Plus and a prefix of 'NGY'.

NYC Medicare Advantage Plus members have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing. As a participating Medicare Advantage PPO provider with Vermont Blue Advantage, you are considered participating for these members.

Electronic claims for NYC Medicare Advantage Plus members are submitted to Blue Cross VT for processing through VBA BlueCard. Paper claims are submitted to VBA, PO Box 260755, Plano, TX 75026.


March 16, 2022

Temporary/Emergency Payment Policy for Telephone Only (CPP_24)

The policy is updated effective April 1, 2022 to (1) add the following codes: 90785, 90849, 90853, 96110, 96127, 96160, 96161, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 99497, 99498; and (2) remove the following codes: 90833, 90826, 90838, 90896, 98961, 98962, 99498, 99496; and (3) clarify when the -V3 and -V4 modifiers should be billed.


March 3, 2022

Prefix List updated for 2022

The Prefix list for Blue Cross VT, CBA, New England Health Plan/Access Blue New England and VBA has been updated for 2022. Click here to view.


February 25, 2022

Medical Policy Updates for May 1, 2022

View the details of the update.


February 24, 2022

COVID-19 Monoclonal Antibody Treatment

This document has been updated to reflect the most recent information—review details.


February 24, 2022

Telemedicine Payment Policy (CPP_03)

The policy will be updated effective April 1, 2022, to add the following codes: 92507*, 92521*, 92522*, 92523*, 92524*, 0362T*, 96110*, 96127*, 97153*, 97154*, 97155*, 97158*, 97164*. The updated policy can be located on the Provider Policies webpage, in the Provider Payment Policies section.


February 23, 2022

Account Receivable Created and Applied on Provider Vouchers

Changes will be effective March 8, 2022. Click here for full details.


February 11, 2022

Telemedicine and Telehealth Medical Policy Effective April 1, 2022

Updates to our original notice are available here.


February 10, 2022

Vermont Blue Advantage Prior Authorization Reminder for Transferring Members
 
As of January 1, 2022, Vermont State Teacher Retirement System (VSTRS) members that are eligible for Medicare have their benefits through Blue Cross of Vermont’s affiliate, Vermont Blue Advantage (VBA). Any prior authorization requests previously approved by Blue Cross, need to be sent to VBA per CMS guidelines.
 
PA processes are explained in the VBA orientation materials.


February 9, 2022

Vermont Blue Advantage (VBA)

As of January 1, 2022, Vermont State Teacher Retirement System (VSTRS) members that are eligible for Medicare have their benefits through VBA. VBA operates independently of Blue Cross Vermont. Questions related to VBA benefits, eligibility, prior approval, claim processing, etc., must be directed to VBA Provider Service at (844) 839-5122. Hours of operation are Monday through Friday, 8am - 5pm EST.

Notes: 

  • VBA is a Medicare Advantage plan. Not all provider types are eligible to enroll as participating in the Medicare Advantage network (e.g., naturopathic physician). 
  • VBA claims need to be billed using CMS guidelines. Electronic claims are still sent to Blue Cross, but paper claims must be mailed directly to VBA, PO Box 260755, Plano, TX 75026.

*Non-Medicare members with Vermont State Teacher Retirement System (VSTRS) remain with Blue Cross VT.

Click here for a short orientation on VBA. Or, if you would like direct training, please contact your provider relations consultant at providerrelations@bcbsvt.com or phone at (888) 449-0443, option 1.

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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 Yanicak, 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