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
December 20, 2024
New & Revised Codes for January 1, 2025 (Adaptive Maintenance)
Review full details here.
December 19, 2024
Updates to Payment Policies
The below policies are updated, effective January 1, 2025. The changes noted below align the policies with the January 1, 2025, updates to Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding system (HCPCS) and when applicable, Vermont mandates.
Telemedicine (CPP_03)
- Policy moved to new template
- Updates made in alignment with Appendix P of the CPT® Manual
- Added codes: 96041, 98000 - 98007 (newly established by American Medical Association (AMA) effective 01/01/2025)
- Deleted code: 96040 (expired code as of 12/31/2024)
- Updated code: G2211 (referencing Corporate Payment Policy CPP_39 (Office & Outpatient Evaluation and Management Visit Complexity G2211)
- Removed codes: 99212-99215, 99202-99205
- Removed modifier - GT
Telephone-Only Services (CPP_24)
- Policy moved to a new template
- Updates made in alignment with Appendix T of the CPT® Manual
- Updates to comply with Vermont 108 mandates that commercial health insurers pay for medical services delivered by telephone (audio only) at the same rate as for the
equivalent in-person service. - Updated policy and regulatory guideline sections of the policy
- Removed deleted codes: 99441-99443 (expired codes as of 12/31/2024)
- Added codes: 98008-98015 (newly established by AMA effective 01/01/2025)
- Removed modifiers -V3 & -V4
The policies have been posted tot he Provider Policies page https://www.bluecrossvt.org/providers/provider-policies under Provider Payment Policies.
December 12, 2024
Updated: New and Revised Payment Policies effective February 1, 2024
December 2, 2024
2025 FEP PA
2025 Federal Employee Program List of Prior Approval Requirements have been posted. The only change for this year is that High-Cost Drugs have been retitled to Medical Benefit Drugs.
View PA list here.
November 26, 2024
2025 Holiday Observance Schedule
November 19, 2024
Clear Claim Connection (C3)
The Clear Claim Connection tool is available again on the Provider Resource Center.
If you are not familiar with this tool, details about C3 are located in our on-line Provider Handbook: www.bluecrossvt.org/documents/provider-handbook, starting on page 84 under Clear Claim Connections (C3).
November 14, 2024
Revised Medical Policies effective February 1, 2024
Read full details.
November 13, 2024
2025 FEP MAC is now available
If you need a copy, please contact provider relations at providerrelations@bcbsvt.com or phone (888) 449-0443 option 1.
November 12, 2204
Prior Approval Portal unavailable from 5:00 p.m. (EST) on Wednesday, November 13, 2024, until 12:00 p.m. (EST) on Thursday, November 14, 2024
In our ongoing effort to provide you with the best possible service, we are conducting scheduled maintenance on the Prior Approval Portal.
During this maintenance window, you will not be able to access the Prior Approval Portal. We apologize for any inconvenience this may cause and appreciate your understanding as we work to enhance the portal's performance and reliability.
Maintenance Details
- Start Date and Time: Wednesday, 11/13 @ 5:00 p.m. EST
- End Date and Time: Thursday, 11/14 @ 12:00 p.m. EST
Please make sure to complete any critical tasks or transactions before the maintenance begins. We will make every effort to minimize the duration of the downtime and restore normal portal functionality as quickly as possible.
Thank you for your patience and cooperation.
If you have any urgent inquiries or concerns during the maintenance period, please contact our support team at 800.924.3494.
October 31, 2024
Home Infusion Therapy Program
Blue Cross Vermont members now have another option for receiving care and infusion therapy treatment at home with our new Infusion Therapy program. Please review our letter sent to applicable providers for details on how the program will work for members and providers.
October 29, 2024
Add on Code G2211
Effective with dates of service on or after January 1, 2025, we will deny additional payment for add-on code G2211. We have a new Payment Policy CPP_39 "Office & Outpatient Evaluation and Management Visit Complexity G2211" posted to our Provider Policies page under Payment Policies.
October 21, 2024
Revised Medical Policies effective January 1, 2024
October 21, 2024
ClaimsXten-Select™ upgrade for January 1, 2025
September 30, 2024
REVISION to PREVIOUS NOTICE – Payment Policy Update
Effective December 1, 2024, the Payment Policy for Observation Services and Other Services Incidental to Inpatient Admission has been updated to include the following:
- Policy moved to a new template, signature updated and grammatical changes
- 48-hour window for hospitals paid on a discount-off-charge basis for services rendered prior to inpatient admission before they may be billed separately changed to 72 hours to align with hospital paid on DRG basis
- References section added
- Coding table edited with the following:
- deleted 99217, 99218, 99219, and 99220
- added 99221, 99222, 99223, 99238, and 99239 as eligible
- replaced 99224, 99225, and 99226 with codes 99231, 99232, and 99233 as not eligible for payment. “Not Eligible for Payment” has been clarified to mean that Observation Services are not eligible if the length of stay extends more than 48 consecutive hours.
- Other language changes made throughout for clarification purposes only
September 30, 2024
Preventive Guide Update
The preventive guide is updated, effective October 1, 2024, with the following changes:
September 27, 2024
New and Revised Medical Policies effective December 1, 2024.
Review full details here.
September 25, 2024
Virtual Event with AAPC – Blue Cross VT’s Implementation of Act 111
Tom Weigel M.D., Chief Medical Officer for Blue Cross VT is joining the Newport Vermont chapter of AAPC on October 8 for their virtual event to discuss the State of Vermont’s Act 111 (H.766) implementation at Blue Cross VT. Act 111 includes changes to prior authorization, step therapy, health insurance claims, and provider contracts. Learn more and register.
September 19, 2024
Our Partnership with Rawlings
Effective October 1, 2024, Blue Cross® and Blue Shield® of Vermont has partnered with Rawlings Company LLC (Rawlings) for the administration of subrogation, workers' compensation, and coordination of benefits. Rawling is an industry leader in this field.
If you receive an inquiry from Rawlings, please respond to the inquiry promptly.
September 18, 2024
Preventive Guide Update
The preventive guide is updated effective September 1, 2024. The changes and revisions are detailed in the guide starting on page 54.
September 16, 2024
New & Revised Codes for October 1, 2024 (Adaptive Maintenance
Review full details here.
- 12-20-24: New and Revised Codes for January 1, 2025 (Adaptive Maintenance)
- 12-12-24: Updated – New and Revised Payment Policies effective February 1, 2024
- 11-26-24: 2025 Holiday Observance Schedule
- 11-14-24: Revised Medical Policies effective February 1, 2025
- 10-31-24: Home Infusion Therapy Program Provider Notice
- 10-21-24: Revised Medical Policies effective January 1, 2025
- 10-21-24: ClaimsXten-Select™ upgrade for January 1, 2025
- 09-27-24: New and Revised Medical Policies effective December 1, 2024
- 09-19-24: Blue Cross VT partnership with Rawlings Company LLC
- 09-16-24: New and Revised Codes for October 1, 1024 (Adaptive Maintenance)
Act 111 (H.766)
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.
Contact us at providerrelations@bcbsvt.com to be added to our email list.
Claims Submission Requirements
If you are submitting a claim for services ordered by a Vermont Blueprint for Health primary care provider for a qualifying service and member, there are specific claim submission requirements that must be followed for the claim to bypass the prior authorization requirements automatically.
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.
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.