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
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)
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 membre 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.
May 21, 2024
Bariatric Surgery Medical Policy
Starting June 1, 2024, the Medical Policy for Bariatric Surgery now considers revision surgery to address severe gastroesophageal reflux disease refractory to medical treatment as medically necessary. The complete policy can be reviewed on the Provider Policies area of our provider website.
May 16, 2024
Credentialing and Re-Credentialing is moving to Verisys.
Review full details here.
April 29, 2024
Medical Policy Updates for July 1, 2024
Review full details here.
April 25, 2024
CXT Upgrade will occur on July 1, 2024
Review full details here.
April 24, 2024
Feedback Informed Treatment (FIT) Workshop
May 31, 2024 | 12:00 p.m. - 1:00 p.m.
Join us for a unique opportunity to learn more about Feedback Informed Treatment (FIT). Research suggests that therapists that routinely measure client change and the therapeutic relationship have a higher rate of positive outcomes. In addition, FIT helps alert providers to problems in the therapy earlier, which allows them to respond before clients drop out. Over 100 therapists across Vermont have been using FIT for years and benefitting from participation in consultation groups that help interpret and understand the data gathered from clients.
This free, one-hour overview of FIT is available to therapists who are part of the Blue Cross Vermont network. Learn more about this valuable tool and how to be a part of a strong Vermont cohort of FIT users. Email Kristin Fletcher at fletcherk@bcbsvt.com for the meeting link and more information.
April 23, 2024
Community Home Infusion Administrative Reimbursement Review
Is underway, review full details here.
April 22, 2024
New Medical Policy for Private Inpatient Hospital Rooms
Review full details here.
April 22, 2024
Home Infusion Therapy Fee Schedule Analysis
We are conducting an analysis of our community fee schedules for National Drug Codes (NDC). 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.
Review full details here.
April 22, 2024
State of Vermont Employer Group Benefit Changes for May 1, 2024
Review full details here.
April 17, 2024
Updated Prefix Listing
The prefix list has been updated and posted here.
April 2, 2024
Preventive Care Guide Updates
There were five additions and three clarifications to the guide for April 2024. The details are located on page 54 and 55 of the guide located here: https://www.bluecrossvt.org/documents/preventive-care-guide
January 24, 2024
Updates to MD Rx for April 1, 2024
We completed our 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, bioengineered skin, and temporary codes.
Updates will be made to the community fee schedule on April 1, 2024.
March 27, 2024
Updated New & Revised Codes for April 1, 2024 (Adaptive Maintenance)
View our latest correspondence to learn about new and revised codes.
March 7, 2024
IMPORTANT HEDIS Data Collection Update
Our HEDIS data collection is on hold until further notice. If you receive a HEDIS request for medical records for a Blue Cross VT patient from anyone, please do not release the medical records and contact the provider relations team (888) 449-0443, option 1. We will post an updated notice once we are ready to resume.
March 1, 2024
Change Healthcare Incident Response
In immediate response to the reported cyber security incident with Change Healthcare on February 21, Change Healthcare has taken most of its applications offline. This means that Change Healthcare cannot post claims (837) files and bulk eligibility verification (270/271) transactions. If you are impacted by this incident, visit our Change Healthcare Incident Response Page for some options until connectivity is restored.
- 06-25-24: Code 33274 Prior Authorization Required for Dates of Service
September 1, 2024 or After - 06-14-24: New and Revised codes for July 1, 2024 (Adaptive Maintenance)
- 05-16-24: Credentialing and Recredentialing Communication Updates
- 04-29-24: Medical Policy updates for July 1, 2024
- 04-25-24: CXT upgrade for July 1, 2024
- 04-23-24: Community Home Infusion Administration Reimbursement Review
- 04-22-24: New Medical Policy for July 1, 2024
- 04-22-24: Home Infusion Therapy Community Fee Schedule Analysis for Possible Changes July 1, 2024
- 04-22-24: State of Vermont Employer Group Benefit Changes for May 1, 2024
- 03-28-24: MD Rx (including categories of select pathology, laboratory, bioengineered skin, and temporary codes) update for April 1, 2024
- 03-27-24: Updated New & Revised codes for April 1, 2024 (Adaptive Maintenance)
Provider Handbook
Access our Provider Handbook for a comprehensive reference of resources and requirements for Blue Cross providers.
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.