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

September 30, 2022

Preventive Guide Updates for October 1, 2022

September 30, 2022

Medical Policy updates for December 1, 2022

Find the details of the updates.

September 29, 2022

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

Learn about new and revised codes.

September 27, 2022

Out-of-Network Services Claim Processing Policy and Procedure

This new policy/procedure is implemented as of October 1, 2022. View the policy/procedure.

September 26, 2022

New Prior Approval Database – Delayed

We apologize, but there is a delay in the release of this new tool.  Future notices regarding the new go live date will be posted her.

September 2, 2022

First round of our provider portal upgrades are here!

Beginning Wednesday, September 7, 2022, when you log into the Provider Resource Center (PRC), you will now see the same great tools you're used to with the added benefits of:

  • A more modern look and feel
  • Centralized placement of member benefit and eligibility information, making it easier than ever to find the information you need
  • The documents and resources you need most available with the click of a button
  • And more!

For your convenience, we have updated our PRC Reference Guide with new instructions and tips to get the most our of the PRC.

Designed with your feedback in mind and the goal of providing you with the best tools available, the enhancement to our provider portal won't stop here. Over the course of the next month, we will be reaching out to request feedback on these enhancements and additional upgrades you would like to see. Please contact your provider relations consultant if you have immediate feedback or questions about these enhancements.

August 31, 2022

MD Rx Fee Review

We are conducting an analysis of our community fee schedules for Health Care Procedure Coding System (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 November 1, 2022.

August 31, 2022

Single-Photon Emission Computerized Tomography (SPECT)

Effective October 1, 2022, SPECT codes 78803, 78830, 78831, 78832 prior approval requests for Blue Cross VT members are managed by AIM Specialty Health.

Prior approval requests can be done through the AIM on-line prior approval tool, located at aimspecialtyhealth.com or by phone at (800) 701-0080.

SPECT prior approval requests for New England Health Plan/Access Blue New England members with a Vermont primary care provider must still be sent to Blue Cross VT (not AIM) for review and decision.

August 26, 2022

New Outcomes-Based Chiropractic Quality Initiative 

This initiative will be effective November 1, 2022. Learn more details about it.

August 22, 2022

Medical Policy Updates for November 1, 2022

Click here to view the details of the updates.

August 19, 2022

Poplar Healthcare PLLC is In-Network!

As of August 1, 2022, this multi-specialty anatomic pathology laboratory is part of our network. An updated list of all in-network independent laboratories has been posted.

August 19, 2022

ClaimsXten-Select™ Upgrade

ClaimsXten-Select™ upgrade will occur on Tuesday, November 1, 2022. View full details.

August 18, 2022

Medication Therapy Management (MTM) Pharmacy Services Payment Policy

Effective November 1, 2022, our MTM program will move from a pilot to a live program. Details on requirements can be located in the payment policy.

July 29, 2022

REVISED: Medical Policy Updates for October 1, 2022

Click here to view the details of the update.

July 26, 2022

Advanced Imaging Services for "UNS" members need pre-certification effective August 1, 2022

Blue Cross and Blue Shield of South Carolina/National Alliance has advised that effective August 1, 2022, certain advanced imaging services for University of Vermont Health Network Employees* (prefix UNS) require pre-certification. Pre-certification is obtained through National Imaging Association (NIA) at (888) 376-6544. Click here for full details.

July 21, 2022

NEHP/ABNE Prior Approval for Advanced Imaging Radiology Services

Historically, we automatically approved advanced imaging radiology services requiring prior approval for NEHP/ABNE members. Starting September 1, 2022 advanced imaging radiology services requiring prior approval will be reviewed against medical criteria for a decision.

Click here for the complete notice.

July 19, 2022

RADV Project

We have partnered with Reveleer for the medical record retrieval of 2021 claims identified in the RADV project. If you received a request from Reveleer, please be sure to respond promptly following the instructions they provide.

If you have any questions about this notice, contact the provider relations team at providerrelations@bcbsvt.com or phone at (888) 449-0443, option1.

If you have 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.

July 18, 2022

Pediatric COVID Booster 0074A

This service is eligible retroactive to 5/17/22. As the eligibility was implemented retroactively, some claims were denied or returned in error.

  • Claims that denied through a provider voucher have been identified and will be adjusted through a future provider voucher.
  • Claims that were returned to your practice with a cover letter need to be submitted again for consideration of benefits.

Thank you and if you have any questions, please contact your provider relations consultant. If you are not sure who that is, please email providerrelations@bcbsvt.com or call (888) 449-0443, option 1 and you will be directed.

July 13, 2022

The Provider Portal is Getting an Upgrade

We are excited to announce that you will soon have access to an upgraded portal! Designed with your feedback in mind and the goal of providing you with the best tools available, our enhanced portal will feature the same great tools you’re used to with the added benefits of:

  • A more modern look and feel
  • Intuitive placement of member benefit and eligibility information, making it easier than ever to find the information you need
  • The documents and resources you need most available with the click of a button

You will still be able to access the portal using your existing links and credentials and do not need to do anything at this time. Please keep an eye out for more information about the launch coming later this month.

July 13, 2022

Provider Satisfaction Survey for Calendar Year 2021

It’s time for our annual Provider Satisfaction Survey.  The survey is being mailed next week and we hope you will participate.   

Your feedback is important and appreciated. This survey is your opportunity to share from your perspective, where we’re doing well and where we can focus on improving. You can also expand beyond the survey questions and share with us any other experiences you have had with Blue Cross VT over the past 12 months. 

Please note, the survey is administered by our contracted vendor, SPH Analytics.  

June 30, 2022

COVID Vaccine and Administration for Pediatric Patients Age 6 months to 4 years

As of July 1, 2022 are billable. The codes for these services are 91308, 0081A, 0082A and 0083A.  The eligibility of these services will be retroactive to June 17, 2022 the date the CDC approve the use of these services.

June 29, 2022

Preventive Guide Updates for July 1, 2022

Click here for the complete preventive guide.

June 29, 2022

Medical Policy Updates for September 1, 2022

View the details of the update.

June 28, 2022

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

Learn about new and revised codes.

June 23, 2022

Case Management for Care Coordination

Visit our Provider Forms & Resources page for more details.

June 10, 2022

Observation Services and Other Services Incidental to Inpatient Admission Payment Policy (CPP_07) (formerly - Observation Services)

This payment policy has been updated effective July 1, 2022. The update (1) amends the title of the policy to include other services (besides observation services) that are incidental (and inclusive) to inpatient admission, (2) moved the document precedence section to the end, (3) added language at the beginning of the policy to clarify when services will be considered incidental (and inclusive) to an inpatient admission, and (4) updated the language explaining when observation services are separately payable versus when they are not separately payable.

View the updated policy.

June 9, 2022

AIM Clinical Appropriateness Guidelines

Effective September 11, 2022 there will be updates to these guidelines. View the full details.

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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