Blue Cross of Idaho uses our One-to-One Newsletter to share upcoming important information or actions that may be required by the provider community.

The information in this newsletter is divided into three categories: Informational (for education only), Actions (requires action on your part) and Reminders (notification or reminder of events and deadlines).

Topics in this edition of the provider newsletter include:

Informational• Benefits of Telehealth on Physical and

Mental Health

• BlueCard Members and Medicare Crossover Claims

• Illuma for BCS/CCS Program

• Introducing the 2020 Blue Cross of Idaho Healthy Rewards Program

• New Faces

• Provider Portal Tool Guide

• Telehealth and Risk-Adjustment Coding

• Value-Based or Pay-for-Performance Models

Action• Change Healthcare

• Good Health Starts with Preventive Care

• Heat Safety Awareness

• Rural Value-Based Payment Program

• Water Safety

• Formulary Changes

Reminders• Medical Policy Updates

M E D I C A L | S U M M E R E D I T I O N

One-to-One Newsletter

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER2

Informational

Benefits of Telehealth on Physical and Mental HealthBlue Cross of Idaho has seen a large increase in the number of telehealth claims. This increase shows us that even during a global pandemic, our members are still getting the high-quality care they need.

Here are some of the benefits of using telehealth during a global health crisis:1

• Lowers cross-contamination caused by close contact between patients and providers

• Helps screen patients who may be sick with a viral infection

• Continues patient engagement to treat acute and chronic health issues

• Reassures patients that they still have access to care, which may help reduce anxiety

Virtual care not only helps to diagnose physical symptoms, but it can also address mental health conditions, especially vital during these challenging times.2 Telehealth visits with a mental health provider can help support and maintain psychological well-being.

Telehealth serves as a helpful tool that patients can use to access routine and preventive care. Blue Cross of Idaho will continue to review the impacts and benefits of telehealth as it continues to become part of our new normal.

Sources:

1Learn more by reading the article: doi.org/10.1177/1357633X20916567

2Learn more by reading the article: doi.org/10.1089/tmj.2020.0068

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BlueCard Members and Medicare Crossover ClaimsHave you received a duplicate denial on a BlueCard claim and cannot find the original claim on the provider portal? Does the patient have Medicare as their primary plan? If so, the original claim may have been part of a Medicare crossover that was sent to the member’s benefit plan to be processed directly.

If you have received a duplicate denial on a claim and the patient lists Medicare as their primary plan, please review the Medicare remittance advice. The remittance advice should note if the claim was crossed over to a plan, as well as state the plan it was sent to. Medicare will not cross any claims to your local plan for BlueCard. It will only be sent to the plan with the patient’s benefit contract. If Medicare has sent the claim to the patient’s plan, your office should contact that plan for the processing details. Blue Cross of Idaho does not have access to other plans’ processing systems.

When calling another plan for claims processing information, you must state that the claim was processed directly as it was part of a Medicare crossover. Benefit plans cannot advise out-of-state providers to reach out to their local plans about Medicare crossovers, according to the Blue Cross Blue Shield Association.

If you have contacted the plan and still cannot get the necessary claim information, Blue Cross of Idaho may be able to help. Please submit your request and questions on the provider portal at provider.bcidaho.com through the claim that was denied as a duplicate. We can work with the plan to get the processing information of the Medicare crossover. This process can take up to 30 days. You may also reach out to the patient for this information. Simply ask them for a copy of their explanation of benefits (EOB).

Blue Cross of Idaho Partners with Illuma Care Connections for Breast Cancer and Cervical Cancer ScreeningsIlluma Care Connections is partnering with Blue Cross of Idaho and specialty healthcare providers to help coordinate care for members. Illuma will reach out to eligible members of the Federal Employee Program by phone to help them schedule their breast cancer and cervical cancer screenings.

As the COVID-19 public health emergency evolves, these important screenings may be overlooked, though the risks are still the same. Illuma can help ensure our members continue to receive the high-quality care we both aim to deliver.

The primary care provider (PCP)-patient relationship is the foundation of quality medical care. A PCP strongly influences a patient’s health practices. The impact you have on your patients may have a positive effect on their quality of care and overall quality of life.

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER4

Introducing the 2020 Blue Cross of Idaho Healthy Rewards ProgramWhat is the Blue Cross of Idaho Healthy Rewards Program?Healthy Rewards is a Blue Cross of Idaho program that rewards Medicare members for taking care of their health. The 2020 program includes healthcare-related activities, and members can earn gift cards valued between $10 and $50 per activity. Activities must be completed and redeemed by December 31, 2020.

Healthcare Activity Reward Amount

Annual wellness visit

• Monitor your physical health; fall prevention

• Improve bladder control

$25

Colon cancer screening

1. FOBT/FIT (at-home kit)

2. Flexible sigmoidoscopy (clinical screening)

3. Colonoscopy (clinical screening)

1. $15

2. $25

3. $50

Breast cancer screening $25

Diabetes eye exam $15

Diabetes kidney exam $25

Diabetes blood test (A1C) screening 1 $25

Diabetes blood test (A1C) screening 2 $25

Osteoporosis screening $25

Rheumatoid arthritis management $25

Flu shot $10

Taking care of your overall health $10

Connecting with your Blue Cross of Idaho care coordinator $25

Know your benefits – MDLIVE $15

Who is eligible and how do members earn rewards? All Blue Cross of Idaho Medicare Advantage members are eligible. To earn rewards, members must complete the healthcare activities and then give the details of the visits – the date of visit, the provider’s name, etc. – to Healthy Rewards online, over the phone or by mail. Then, members can choose their reward.

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Is there a limit to how many rewards members can earn?Activities are based on the member’s gaps in care. Not all members will be eligible for every activity. There will be targeted outreach to make sure members are getting basic preventive services. Members who get preventive screenings can find problems early and limit their exposure to potentially long-term health issues.

How can members sign up for the program?Members can sign up for the Healthy Rewards program by:

• Visiting bcidaho.com/healthyrewards

• Calling 866-501-4334 (TTY: 711)

• Sending their request by mail

Online sign-up is the fastest and easiest way to redeem rewards.

For more information, call quality specialist Trisha Catti at 986-224-3252.

New FacesCody Cockrum, Provider Contract Specialist

Provider Portal Tool GuideAll registered providers and their staff can use the Blue Cross of Idaho provider portal once they have an approved user ID.

If you have any problems logging into your account, here are a few tips that may be helpful:

• Try entering our web address into the search bar instead of using a favorites link. Sometimes favorites or bookmarked links can be outdated, causing issues if the provider portal has been updated.

• Clearing your cookies and cache routinely to keep your browser healthy and working smoothly.

• See if your browser allows pop-up blockers for our web page.

You can find a troubleshooting guide on our website by selecting Forms & Resources then Browser Troubleshooting in the Resources column.

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER6

Risk-Adjustment Criteria for Coding TelehealthDue to the COVID-19 public health emergency (PHE) and social distancing guidelines, Blue Cross of Idaho is covering telehealth services for our fully insured members through December 31, 2020. Telehealth is a service where providers can meet with patients through audio/video communication technology.

Risk-Adjustment Criteria for TelehealthTelehealth services are eligible for risk adjustment when performed by an approved provider and carried out using real-time audio/video technology. The Section 1135(b) waiver of the Social Security Act allows phones with audio/video capabilities, such as FaceTime, Skype, etc., to be used for telehealth services during the COVID-19 PHE. Diagnoses from telehealth will be accepted for hierarchical condition category (HCC) capture for both Medicare Advantage and Qualified Health Plan (QHP) patients under the Centers for Medicare and Medicaid Services (CMS)-HCC and the U.S. Department of Health and Human Services (HHS)-HCC risk-adjustment models.

Approved Risk Adjustment ProvidersPhysicians, nurse practitioners, physician assistants, physical therapist, occupation therapist, speech-language pathologist, licensed clinical social workers, clinical psychologists and those qualified to provide evaluation and management services.

Billing Requirements for Telehealth Risk AdjustmentTelehealth services must be submitted with place of service “02” or with both the CPT/HCPCS telehealth modifier “95” and the place of service where the service would have been performed in person.

Documentation Requirements for Telehealth Risk AdjustmentThe mode of communication and written or verbal consent from the patient for telehealth interactions must be documented. Include notes within the medical records to state why certain elements (e.g., vitals) could not be obtained due to services being given through telehealth.

Example: This visit was carried out with the use of a real-time interactive audio/video telecommunications system. Patient

consent for telehealth visits was obtained on (DD/MM/YYY). Vitals were not obtained due to services being performed virtually.

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Common and expanded covered services during the PHE:

• Outpatient evaluation and management services (99201-99215)

• Medicare annual wellness visits (G0438-G0439)

• Preventive exams1 (99381-99387; 99391-99397)

• Home visits (99341-99345; 99347-99350)

• Psychological and neuropsychological testing (96130-96133; 96136-96139)

• Therapy services, physical and occupational therapy (97161-97168; 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507)

• Emergency department or initial inpatient consultations (G0425-G0427)

• Follow-up inpatient hospital or skilled nursing facility consultations (G0406-G0408)

1 Preventive exams are only acceptable for risk-adjustment HCC capture under the HHS-HCC model for QHP plans.

CMS has published a full list of services that may be provided through telehealth at: cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER8

Value-Based or Pay-for-Performance ModelsProviders and payers across the country are actively looking for ways to fight the rising cost of healthcare. Value-based or pay-for-performance models are quickly becoming the leading methods used to lower the cost of healthcare while improving quality of care and patient health outcomes.

The Healthcare Operations Clinical Quality Outreach Team gives support and guidance to networks and providers that operate in value-based agreements.

These provider groups and networks have access to a variety of reporting tools, including a monthly gap-in-care report, to identify patients that need preventive screenings and condition-based care, such as lab monitoring or medications. They also get a monthly quality scorecard that captures their member volume and quality metrics compliance rates.

Our new Value-Based Providers and Partners webpage has more resources for value-based providers, such as:

• HEDIS resource guides

• Non-standard supplemental data guidelines for submission

• Standard supplemental data guidelines for submission

• Provider/member educational materials

• Annual wellness calendar

To view the resources above and for more information on value-based care, visit bcidaho.com, select Forms & Resources then select Value-Based Providers & Partners.

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Action

Change HealthcarePayment Integrity Blue Cross of Idaho partners with outside vendors to review payment of claims to ensure payment integrity, billing accuracy and adherence to contracts with its members and providers. Blue Cross of Idaho, or its vendors, may ask providers to submit medical records and other billing documents to verify billed charges and services. The medical records or other supporting documents are reviewed to compare how the submitted claims were coded with what is documented. This makes sure that claims are coded correctly and in accordance with nationally recognized coding edits.

Providers must send the requested record of documentation within 14 business days or the timeframe specified in the provider’s contract. If the provider does not respond to the request in a timely manner, the claim will be denied due to a non-receipt of records.

PrePay Medical Records ProcessThe process below outlines how Blue Cross of Idaho and Change Healthcare (CHC) request medical records from providers and facilities. Please refer to PAP 295 and the frequently asked questions (FAQs) page on the provider portal at providers.bcidaho.com for more information.

CHC will send a request for medical records to the provider using information on the claim. At the same time, Blue Cross of Idaho will deny the claim for no receipt of medical records. This is a pre-payment technical denial and will serve as a placeholder for the claim until the records are received and reviewed at CHC. CHC will list what is being requested – based on what was billed on the claim – within the body of the letter, which will be either faxed, mailed or emailed. If CHC does not get the records within 30 days,

CHC will send a second request. If CHC does not get records after 45 days, CHC will inform Blue Cross of Idaho of “no records received” and the technical denial will stand.

If the provider submits records to Blue Cross of Idaho after the 45-day timeframe, the records will be sent to CHC and the timeline will start over within timely filing limits. The provider may still submit records to CHC within timely filing limits after the technical denial as well. CHC will reopen the case, and a decision will be made within the timeline listed below. Do not submit medical records that CHC has requested through the appeals process as attachments to claims or through the provider portal. Providers should submit their records directly to CHC to ensure faster processing of their claims. To check the status of records requests, providers may email CHC at medicalrecords@changehealthcare.com. CHC will confirm receipt of records or types of records received, but not the status of the claim.

When CHC receives the records, the case is given to a reviewer. CHC will review the records and send a decision to Blue Cross of Idaho within 10 business days. If Blue Cross of Idaho agrees with the decision, the claim will be processed to reflect that decision. If the provider disagrees with the decision, they may follow their appeal rights as defined in their contract and submit their appeals directly to Blue Cross of Idaho.

CHC is a vendor that is contracted directly with Blue Cross of Idaho. They do not handle provider appeals for the PrePay and Insight Review program and cannot answer any claims-related questions.

For faster processing, medical records may be emailed to medicalrecords@changehealthcare.com or faxed to 949-234-7603. CHC no longer accepts medical records by CD or DVD.

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER10

If these options are not available, you may send medical records by mail to:

Change Healthcare 5755 Wayzata Blvd. St. Louis Park, MN 55416

If you have any questions about this request, please call Provider Services at 952-224-8650.

Documentation Requirements for Durable Medical Equipment Blue Cross of Idaho adheres to the Centers for Medicare and Medicaid Services (CMS) requirements for documentation when Blue Cross of Idaho providers dispense durable medical equipment (DME). Please visit med.noridianmedicare.com/web/jddme/policies/documentation-checklists to review the Medicare requirements. CHC uses these requirements when reviewing claims for correct coding and billing. Please make sure that your staff is fully aware of the documentation requirements to dispense DME.

References: Supplier Manual Chapter Documentation Requirements

Face-to-Face Examination (F2F) Written Order Prior to Delivery (WOPD) Dispensing Order, if applicable Detailed Written Order (DWO) Beneficiary Authorization Refill Requirements Proof of Delivery (POD)

Method 1 - Direct Delivery to the Beneficiary by the Supplier The date the beneficiary/designee signs for the supplies is to be the date of service of the claim.

Method 2 - Delivery via Shipping or Delivery Service The shipping date is to be the date of service of the claim.

Method 3 - Delivery to Nursing Facility on Behalf of a Beneficiary

• Continued Need• Continued Use

Medical records documenting all the coverage criteria are met: med.noridianmedicare.com/web/jfa/topics/dme

med.noridianmedicare.com/web/jddme/policies/clinicians-corner

med.noridianmedicare.com/web/jddme/policies/clinicians-corner/checklists

Proper Amendment Documentation Guidelines, Medicare Program IntegritySome Blue Cross of Idaho providers may need review their documentation and make amendments. The amendment requirements to do so are below. Please review this information and follow the guidelines as set forth in the Medicare Program Integrity Manual.

Chapter 3.3.2.5 - Amendments, Corrections and Delayed Entries in Medical Documentation (Rev. 732; Issued: 07-21-17; Effective: 08-22-17; Implementation: 08-22- 17)

This section applies to MACs, CERT, Recovery Auditors, SMRC and ZPICs, as indicated.

A. Amendments, Corrections and Delayed Entries in Medical Documentation

All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered. Occasionally, certain entries related to services provided are not properly documented. In this event, the documentation will need to be amended, corrected, or entered after rendering the service. When making review determinations the MACs, CERT, Recovery Auditors, SMRC and ZPICs shall consider all submitted entries that comply with the widely accepted Recordkeeping Principles described in section B below. The MACs, CERT, Recovery Auditors, SMRC and ZPICs shall NOT consider any entries that do not comply with the principles listed in section B below, even if such exclusion would lead to a claim denial. For example, they shall not consider

SUMMER 2020 11

undated or unsigned entries handwritten in the margin of a document. Instead, they shall exclude these entries from consideration.

B. Recordkeeping Principles

Regardless of whether a documentation submission originates from a paper record or an electronic health record, documents submitted to MACs, CERT, Recovery Auditors, SMRC and ZPICs containing amendments, corrections or addenda must:

1. Clearly and permanently identify any amendment, correction or delayed entry as such, and

2. Clearly indicate the date and author of any amendment, correction or delayed entry, and

3. Clearly identify all original content, without deletion.

Paper Medical Records: When correcting a paper medical record, these principles are generally accomplished by:

1. Using a single line strike through so the original content is still readable, and 2. The author of the alteration must sign and date the revision.

Amendments or delayed entries to paper records must be clearly signed and dated upon entry into the record. Amendments or delayed entries to paper records may be initialed and dated if the medical record contains evidence associating the provider’s initials with their name. For example, if the initials match the first and last name of the practitioner documented elsewhere in the medical records including typed or written identifying information, the reviewer shall accept the entry.

Electronic Health Records (EHR): Medical record keeping within an EHR deserves special considerations; however, the principles specified above remain fundamental and necessary for document submission to MACs, CERT, Recovery

Auditors, SMRC and ZPICs. Records sourced from electronic systems containing amendments, corrections or delayed entries must:

a. Distinctly identify any amendment, correction or delayed entry, and

b. Provide a reliable means to clearly identify the original content, the modified content and the date and authorship of each modification of the record.

C. If the MACs, CERT, SMRC or Recovery Auditors identify medical documentation with potentially fraudulent entries, the reviewers shall refer the cases to the ZPIC and may consider referring to the RO and State Agency.

Proper Documentation Guidelines to Report Drug WasteBlue Cross of Idaho providers are required to bill drug waste with a JW modifier on a separate line from the administered dose. Please review Medicare Advantage Provider Administrative Policy (MAPAP) 107 for more information. CHC will require the medication administration record (MAR) to justify the amount of drug waste that is being billed, if records are requested for that type of claim.

Drug wastage information can be found at cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf, which is from the CMS Medicare Claims Processing Manual (Pub. 100-4). Chapter 17 Drugs and Biologicals Section 40 Discarded Drugs and Biologicals.

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER12

Getting Back to Preventive HealthThe priority of preventive care has changed due to recent world events. As we shift to a new normal, patients’ preventive care cannot be ignored.

Preventive healthcare and close monitoring of chronic health issues can have a huge impact on a patient’s overall health. You can make sure they are up-to-date on their preventive care by reaching out to them to schedule an annual wellness exam to address any gaps in care, including the topics below.

Typical care:• A1c testing

• Cholesterol screening

• Microalbumin screening

• Depression screening

• Diabetic retinal eye exam

Important screenings:• Colorectal cancer – Talk to your patients about different testing options

• Fecal occult blood test

• Flexible sigmoidoscopy

• FIT DNA test

• Colonoscopy

• Breast cancer

• Cervical cancer

• Prostate cancer

Routine vaccines: • Booster immunizations, which protect against tetanus, diphtheria and whooping cough

• Annual flu shot

As your patient’s primary care provider, you have a stronger influence on their health than you realize. Your relationship with your patients can have a huge impact on their lives and help improve their quality of life.

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Heat Safety AwarenessAs temperatures rise, it’s important to talk to your patients about how harmful summer heat can be. In the summer of 2019, more than 50 children died from overheating in hot cars. It can only take 10 minutes for heat to be deadly for children, pets and adults with no or limited mobility.

The American Red Cross lays out these tips to help prevent a tragedy:• Never leave an infant, child or adult with limited mobility or a pet locked in the car

• Make sure that you, your family members and pets are well-hydrated. Avoid drinks with alcohol or caffeine

• Know the heat index and temperature so you can prepare

• Wear loose-fitting, lightweight, light-colored clothing. Avoid dark colors because they absorb the sun’s rays.

If you start to feel like you are overheating and don’t have access to an air-conditioned space, check with your local community to find a cooling center.

Water SafetySummertime gives us many chances to enjoy fun water activities, making it the perfect time to talk to your patients about water safety. Taking part in water activities also raises the risk of drowning. Speak with your patients about staying safe and keeping their families safe while having fun this summer.

The YMCA lays out these guidelines for staying safe around water:

• Never swim alone

• Always wear a life jacket while boating

• Don’t mix alcohol or drugs with water activities

• Keep an eye on children at all times – even if they know how to swim

Learning CPR is a great way to be ready in the event that someone begins to struggle in the water. When these kind of accidents occur, bystanders are often the first people to react and respond.

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER14

Rural Value-Based Payment ProgramUnder value-based contracts, the patient attribution process defines a provider's risk pool, influences their medical loss ratio and determines whether a provider will see shared savings or pay-for-performance incentives. Patient attribution is a key part of population-based payment models.

If providers see patients who have not chosen that provider as their primary care provider (PCP), providers may miss out on the pay-for-performance incentives laid out in their Blue Cross of Idaho contracts. Blue Cross of Idaho members in Idaho counties who have not selected a PCP are placed on lists as “members with an unassigned PCP.” These lists help providers compare records and find patients who they have seen in their office or by telehealth. If you would like a list of members by county, please email Nikki Burroughs at nikki.burroughs@bcidaho.com.

You can easily change a patient’s PCP through the provider portal at providers.bcidaho.com. Your patients can also choose one on the member portal at members.bcidaho.com. If you have patients who are members of Hometown East or Hometown North networks and their insurance card states “unassigned,” they may need help choosing a PCP. We can help your patients choose a PCP so that their healthcare experience can be better suited for their health goals.

Formulary ChangesFormulary changes happen periodically. Please review the appropriate member formulary for the most up-to-date version of the formulary.

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Reminders

Medical Policy ChangesMedical policy provides general guidance for applying Blue Cross of Idaho benefit plans and does not constitute medical advice. Any person applying a medical policy must identify member eligibility, the member specific benefit plan, and any related policies or guidelines prior to applying a medical policy. If there is a conflict between a member-specific benefit plan and Blue Cross of Idaho’s standard benefit plan, the member-specific benefit plan supersedes medical policy. Blue Cross of Idaho medical policies are designed for informational purposes only and are not an authorization, explanation of benefits (EOB) or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the member-specific benefit plan coverage. Blue Cross of Idaho reserves the sole discretionary right to modify all its policies and guidelines at any time.

Medical policy updates effective since the last provider newsletter are summarized below. See the medical policy referenced for complete information.

Policy # Title Summary of changes to policy statement

New Policies

2.04.148 Genetic Testing for Heredi-tary Pancreatic Cancer

Effective 05/20/2020: Added to medical policy library.

5.01.656 Givlaari (givosiran)Effective 6/20/2020: Added to the medical policy library.

1.01.520

Continuous or Intermittent Monitoring of Glucose in interstitial Fluid and Artificial Pancreas Device

Effective 7/22/2020: Added to the medical policy library and combines 1.01.20 and 1.01.30, which are both ar-chived.

5.01.660 Tepezza (teprotumum-ab-trbw)

Effective 07/22/2020: Added to medical policy library.

9.02.505 Dental Services for Acciden-tal Injury

Effective 07/22/2020: Added to medical policy library.

10.01.540 Oversight of Third-Party Entities

Effective 07/22/2020: Added to medical policy library.

Revised Policies

2.01.10Identification of Microor-ganisms Using Nucleic Acid Probes

Effective 5/20/2020: Evidence reviews for central nervous system (CNS), gastrointestinal (GI) and respiratory pathogen panels were updated. Use of CNS and GI pathogen panels remains investigational.

2.02.31 Myocardial Strain Imaging

Effective 06/20/2020: Additional statement: Myocardial strain imaging in individuals who have exposure to medica-tions or radiation that could result in cardiotoxicity is inves-tigational.

2.04.102Whole Exome and Whole Genome Sequencing for Di-agnosis of Genetic Disorders

Effective 06/20/2020: Rapid whole exome or genome sequencing may be considered medically necessary for the evaluation of critically ill infants in neonatal or pediatric in-tensive care with a suspected genetic disorder of unknown etiology, when specified criteria are met.

BLUE CROSS OF IDAHO | MEDICAL NEWSLETTER16

Policy # Title Summary of changes to policy statement

5.01.27 Treatment for Duchenne Muscular Dystrophy

Effective 06/20/2020: P Golodirsen is added to the inves-tigational statement. Title has changed from Eteplirsen for Duchenne Muscular Dystrophy.

9.03.013 Retinal Telescreening for Diabetic Retinopathy

Effective 06/20/2020: Additional Statement: Digital retinal imaging with automated image interpretation is considered investigational for the detection of diabetic retinopathy.

9.03.23 Intravitreal and Punctum Cor-ticosteroid Implants

Effective 06/20/2020: One new medically necessary and two new investigational statements added.

2.04.75 Genetic Testing of CADASIL Syndrome

Effective 07/22/2020: Policy statement revised to remove the requirement for skin biopsy prior to genetic testing.

7.01.07Electrical Bone Growth Stim-ulation of the Appendicular Skeleton

Effective 07/22/2020: Medical necessity statement for pseu-darthrosis added to the policy; statements are otherwise unchanged.

7.01.108 Artificial Intervertebral Disc: Cervical Spine

Effective 07/22/2020: Change in terminology from artificial intervertebral disc arthroplasty (AIDA) of the cervical spine to cervical disc arthroplasty (CDA).

7.01.501 Orthognathic Surgery Effective 06/20/2020: Policy re-organized and moved guidelines into the policy statement.

10.01.500 Cost Effective Medical DrugsEffective 06/20/2020: This change is specifically adding a preferred and non-preferred colony stimulating factor med-ications.

9.01.501 General Coverage Guidelines Effective 07/22/2020: Updates and clarification of criteria that is used.

Archived Policies

01.01.023 Transtympanic Micropressure Applications as a Treatment of Ménière’s Disease

Policy was archived from the medical policy library on 05/20/2020 and will no longer be used.

02.04.072

Gene Expression Testing in the Evaluation of Patients with Stable Ischemic Heart Disease

Policy was archived from the medical policy library on 06/20/2020 and will no longer be used. The tests listed in this policy are no longer commercially available.

01.01.020 Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid

Policy was archived from the medical policy library on 07/22/2020 and will no longer be used. Refer to MP 1.01.520.

01.01.030 Artificial Pancreas Device Systems

Policy was archived from the medical policy library on 07/22/2020 and will no longer be used. Refer to MP 1.01.520.

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Any Questions?MEDICAL MANAGEMENT Questions regarding managed health care/review, preadmission/admission certification or individual benefits management and case management:

• Call: 208-331-7535 or 800-743-1871 (voicemail available after office hours and on holidays and weekends)

MEDICAL POLICY Questions regarding medical policy and clinical criteria:

• Email: HCOMedicalPolicy@bcidaho.com

BLUE CROSS OF IDAHO HELP DESK Questions regarding electronic billing errors, error and acceptance reports:

• Email: edihelpdesk@bcidaho.com

PROVIDER CONTACT CENTER Questions regarding benefits, coverage and authorization:

• Call: 208-286-3656 or 866-482-2250 between 7 a.m.-7 p.m. MT Monday-Friday, EXCEPT closed 2-3 p.m. MT Thursday

For post-service claim questions, log on to our secure website at providers.bcidaho.com and select Contact Us.

PROVIDER RELATIONS Questions regarding coding, contracting or need website training:

• Call: 866-283-5723 or 208-286-3602 • Email: PRproviderrelations@bcidaho.com

MEDICARE-MEDICAID COORDINATED PLAN/IDAHO MEDICAID PLUS

• Call: 208-286-3678 or 866-462-4612• Email: PRmedicaremedicaid@bcidaho.com

FRAUD, WASTE AND ABUSE We encourage anyone who suspects possible fraudulent activity to report it to us. You have the option to remain anonymous. Call the fraud hotline at 800-682-9095 or email fraudreporting@bcidaho.com.