Advanced Claim Editing, Document Processing, Authorization Pre-Check & More

Announcements

We are excited to finally share our newly redesigned Provider Update. This update gives everyone a cleaner and more efficient design.

Sign up here. https://www.bcbswy.com/providers/providers-news-sign-up/

Advanced Claim Editing

We are sharing coding advice to help Providers prepare for our automated claims review process starting March of 2023. These ongoing tips help ensure your claims are properly coded.

Coding Advice

  • BCBSWY will deny preventive medicine, initial or periodic visits (99381 or 99391), when billed in any combination more than eight times in one year when the patient is less than one year of age.
  • BCBSWY will deny preventive medicine, initial or periodic visits (99382 or 99392), when billed in any combination more than seven times in a four-year period when the patient is between one and four years of age.
  • BCBSWY will deny 93010 when billed with an E/M service in the office setting and 93005 (ECG tracing) is not also billed.

PDFs Help Optimize Document Processing

For prior authorizations and medical attachments, please use the .PDF file format as it is optimized and preferred.

You can learn more about Adobe PDFs in the third-party link here. https://get.adobe.com/reader/

Authorization Pre-Check Tip

Providers can use the Authorization Pre-Check tool to save time and get needed information without calling the Member Center.

The tool allows you to determine if a prior authorization is required for any BCBSWY member upfront. Visit Availity.com to use it at any time.

Directory Validation Reminder

Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations. The No Surprises Act (NSA) requires you confirm this information with us every 90 days. Please see the guide here.

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Fewer Hassles. Better Service.

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