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Important Announcements for Blue Cross Blue Shield-Massachusetts Providers - June 2017

Tuesday, June 6, 2017   (0 Comments)
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Important Announcements for
Blue Cross Blue Shield-Massachusetts Providers - June 2017
Jennifer Warkentin, Ph.D., Director of Professional Affairs for MPA
MPA holds regular meetings with health plans to advocate for positive changes, voice members' concerns, educate the insurers about research and innovative evidence-based assessments, treatments, and standards of care, and learn about initiatives and issues the health plans are working on. We also work to ensure compliance with state and federal laws and regulations, particularly around parity. Following is a list of updates and responses to recent provider concerns:
  • Expansion of diagnoses for 90837 policy: BCBS-MA is examining research on a number of additional diagnoses to add to their list of approved options for 90837. Fortunately, such changes to this policy would be able to go into effect this year, instead of having to wait until January 1. MPA will keep providers posted about changes as we receive that information. As a reminder, the primary diagnostic code is the determining criteria- submissions with a primary diagnosis not listed in the policy will be rejected unless providers get prior authorization (use the MA Behavioral Health Level of Care Request Form).

  • Documentation for 90837: Some MPA members have expressed concern about making sure their documentation of 90837 is sufficient. I verified with BCBS-MA that their requirements for using that code are the same as any other code they cover. Providers should review the criteria for medical necessity (we have a copy here).
  • Updating provider information: BCBS-MA is asking that providers make every effort to update the information posted on the online provider directory. Members use this directory as their primary search tool and it can be frustrating when information like contact info and specialties served are incorrect.

  • Indicating openings in your practice: BCBS-MA have also asked that providers respond to the emails sent out to determine which providers have openings in their caseloads. Responding that you have openings DOES NOT mean that you are required to take the members that contact you- it's simply used to help members narrow the list of potential providers. Similarly, if you are not taking new patients, it would be helpful if you included that in your voicemail or called back the member to let them know you don't have openings. It can be frustrating for members to call several providers and leave messages and then not hear anything back from them.

  • Coverage of case consultation (90882) and family consultation (90887) codes: BCBS-MA verified that they do not cover these codes, but has stated that they are considering options to include them at some point. MPA argues that reimbursing for these codes, and thereby allowing providers sufficient time to engage in case coordination and care, would demonstrate the value that BCBS-MA places on integrated healthcare. As it currently stands, providers who engage in this often vital aspect of care are doing so without reimbursement. We will continue to advocate for the addition of these codes to the BCBS-MA fee schedule.

  • Copayments for Health and Behavior codes: Currently, copayments vary for health and behavior codes (96150-96155) because those codes are categorized as medical. This can cause confusion for both providers and consumers, especially since the codes are designed for behavioral health interventions targeting physical health. BCBS-MA report they have been looking for a solution that will work within their system. MPA will continue to emphasize the importance of changing the classification of these codes from medical specialists (which have a higher co-pay) to behavioral health, so that co-pays and deductibles are consistent across all behavioral health and substance use services.

  • Advance notice of fee changes: MPA has continued to emphasize the importance of releasing the details of a fee schedule change prior to the schedule going into effect, especially given the delay that occurred last year. BCBS-MA has been aware of our concerns about this and, in a positive development, are now working to provide more advance notice prior to the annual September 1 fee changes. Previously BCBS-MA argued that legally they were only required to notify providers in advance that the fee schedule would change, and therefore did not see sufficient cause to change practices. MPA will update our members on any additional information we have on this as the summer progresses.
We will continue to meet with BCBS-MA quarterly to raise your concerns and assist in improving all psychological services for BCBS patients.

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