Availity Secure File Transfer Hold Coming Up
Availity will hold all files through Secure File Transfer, including Responses to Providers (999, 277CA, IBR, etc.), starting at 5 p.m. on Friday, July 21. Secure Transport will be taken offline for the production upgrade beginning at 7 p.m. Secure Transport will be back online at approximately 10 p.m.
New Prior Authorization Tool Coming 9/5/2023
We’re updating our Prior Authorization tool to save Providers time and to further simplify workflows Sept. 5, 2023. Some of the features include the following:
View more real-time information in Availity.
Reduced authorization wait times with an enhanced automated process.
Use a distinct member name for newborn baby authorizations.
Stay tuned for more information.
Claims Adjustment Forms and Instructions Updated
We recently updated our Claims Adjustment Forms and their corresponding instructions to add more clarity. These instructions will help avoid duplicative submissions and save you time.
See Updated Forms
HCPS Code Availability Reminder
BCBSWY will not accept a medical claim form for reimbursement if the form has a “not otherwise specified” code submitted when a proper HCPCS code is available.
For example, a claim submission on a HCFA-1500 for HCPCS code J3490 with an NDC listed for Bupivacaine, when the proper HCPCS code J0665 is available for billing will be denied.
BCBSWY will not accept billing of G2086. While we will reimburse for the services rendered per the benefits of a member’s contract, they must be billed under the distinct CPT or HCPCS codes for the services rendered.
ASCs billing for reimbursement of L8699 for implantable supplies must include invoices with their submitted claims. Otherwise, they will be denied.
Dental Medical Billing Reminder
Medical providers submitting a dental claim for teeth related incidents using a HCFA-1500 or UB-04 should bill for all indications during a member visit.
For example, if you are treating a member with an abscess of a tooth, ensure you are billing the medical signs and symptoms in addition to the abscess diagnosis code. These additional codes help determine the medical benefits available for the member and reduce appeals.