Transcript Highmark WV Updates

Highmark Blue Cross Blue Shield West Virginia
Joyce Landers,Director Provider Relations
Autism Spectrum Disorder
As announced in the October 2011 issue of Provider News, the West Virginia
Legislature passed a bill mandating coverage for diagnosis and treatment of Autism
Spectrum Disorder (ASD) in children. Highmark Blue Cross Blue Shield West
Virginia insured group policies issued or renewed on or after Jan. 1, 2012, will
include coverage for diagnosis and treatment of ASD in children ages 0 months to
18 years. Coverage will include medically necessary treatments ordered or
prescribed by a certified behavior analyst for any child diagnosed with ASD. In
accordance with the legislation, Highmark West Virginia may require documentation
of a treatment plan developed by a certified behavior analyst that incorporates
comprehensive evaluations or re-evaluations of the child that can be reviewed upon
request by Highmark West Virginia every six months, along with semi-annual
progress reports.
www.highmarkbcbswv.com
Highmark Blue Cross Blue Shield West Virginia
Announces
A Limited Extension For Acceptance Of Version 004010
Electronic Transactions
The HIPAA mandate to use Version 005010 for all electronic claim, inquiry and related
transactions becomes effective Jan. 1, 2012. Many providers and trading partners have
successfully made the transition to the 005010 format and have assured themselves of
no interruptions in claims processing and payment due to the use of non-compliant
transactions. These business partners can now turn their attention to the complex
implementation of ICD-10 for claims coding, as well as to other health care reform
initiatives. However, there are a number of other providers and
trading partners who have not been as successful in their 005010 migration efforts. As
announced in a Special eBulletin posted online Dec. 2, 2011, for these business
partners, Highmark West Virginia, in alignment with CMS’ direction, will continue to
accept Version 004010 transactions for 90 days past the Version 005010 compliance
date of Jan. 1, 2012.
Radiation Therapy Authorization Program to Take
Effect Jan. 1, 2012
As announced in the October 2011 issue of Provider News and in hospital and professional
Special Bulletins dated Aug. 1, 2011, in an effort to help ensure that the radiation
therapy services provided to our members are consistent with nationally recognized clinical
guidelines, Highmark West Virginia has contracted with CareCore National, LLC to
provide medical necessity review and authorization where applicable for select radiation
therapy services, effective with dates of service of Jan. 1, 2012, and beyond. A follow-up Special
Bulletin dated Dec. 1, 2011, recently sent to Highmark West Virginia network oncology and
urology providers included additional information regarding the Radiation Therapy
Authorization Program which takes effect Jan. 1, 2012.
The Special Bulletin included:
• A list of products included in the program
• Step-by-step instructions for submitting authorization requests via NaviNet • Information
about registering treatment plans prior to
Jan. 1. 2012, for members who are currently in treatment
• A frequently asked questions and answers document
Watch for New Member ID Cards
As part of our official name change to Highmark Blue Cross
Blue Shield West Virginia, all member ID cards are being
converted to include the new name and logo. The revised ID
cards were recently distributed to members. An example of
the new ID card is shown at right. Providers are reminded to
always check the member’s ID card as well as the member’s
benefits via the Eligibility and Benefits function on NaviNet
prior to performing services.
Attention Anesthesiologists:
Highmark Blue Cross Blue Shield West Virginia applies anesthesia base units to
procedure codes to determine reimbursement. Currently, Highmark West Virginia
obtains these base units from the American Society of Anesthesiologists (ASA). The
Centers for Medicare & Medicaid Services (CMS) also publishes anesthesia base units
on its website.
For the most part, CMS anesthesia base units are the same as the ASA’s; however, for
certain anesthesia procedure codes, the CMS base unit’s value is different. Beginning
April 2, 2012, Highmark West Virginia will begin to use CMS as the sole source for
anesthesia base units rather than the ASA for all Highmark West Virginia business,
including HHIC Medicare Advantage PPO.
Use Appropriate NAIC Codes on Electronic Claims
for HHIC FreedomBlue PPO Members to Avoid
Denials
Plan
Alpha Prefix
Plan Code
NAIC Code
Highmark
BCBS
HKS
363
54828
Highmark BS
HKR
378
54828
HHIC
FreedomBlue
PPO
HKP, HQM
377
71768
Highmark
BCBS
Freedom PPO
FEM
363
71768
Highmark BS
Freedom Blue
PPO
FER
378
71768
* USE OF NAVINET AUTOMATED CARE
MANAGEMENT REQUIRED FOR SUBMISSION OF
ALL SCHEDULED INPATIENT AUTHORIZATION
REQUESTS, EFFECTIVE APRIL 1, 2012 *
Effective April 1, 2012, Highmark West Virginia and Highmark Health
Insurance Company (HHIC) will require all acute-care hospitals and
critical access hospitals to submit their authorization requests for all
scheduled inpatient admissions, including acute-to-acute transfer
requests, through the NaviNet Automated Care Management (ACM)
process.
Electronic Funds Transfer Registration Process
Enhanced through NaviNet
On Feb. 6, 2012, Highmark Blue Cross Blue Shield West Virginia made a change to the Electronic
Funds Transfer (EFT) Registration process to make it more efficient for provider offices. This
change impacts the functions of the NaviNet Security office and the EFT Responsible Party.
Every provider that is NaviNet-enabled with Highmark West Virginia designates someone in their
office as their NaviNet Security Officer. The Security Officer creates NaviNet Users and resets
passwords as well as controls access to specific transactions.
Prior to the enhancement to the process, Highmark West Virginia providers did not have selfservice access to register their banking information.
Highmark West Virginia has streamlined this process to allow the EFT Attestation and Registration
button to be enabled for the Highmark West Virginia NaviNet offices. The NaviNet Security Officer
can now enable/disable the EFT transaction permission for the office. The EFT Responsible party
will be able to attest, electronically via NaviNet, to their position as the Responsible Party within
the office. Separate paperwork is not required to receive the button or change banking
information. The EFT Responsible Party will select only those providers/facilities for which they
are the Responsible Party.
IMPORTANT: There are no changes to your current banking information. You will only need to
electronically attest when you need to make a change to an existing account or register a new
provider.