Claims, Coding, URAC Guidelines & More

Advanced Claims 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 excess units when any provider bills more than one unit of service for a code with an anatomical modifier (E1-E4, FA-F9, TA-T9).

BCBSWY will deny excess units when any provider bills a certain number of units that exceed the daily assigned allowable unit(s) for that procedure for the same member.

BCBSWY will deny excess units when any provider bills a certain number of units that exceed the annual assigned allowable unit(s) for that procedure for the same member.

Upcoming Holiday Closure

BCBSWY is extremely thankful for our provider community and all you do. We will be closed on Thursday, Nov. 24 and Friday, Nov. 25 in observance of the Thanksgiving holiday. 

URAC Guidelines 

As a reminder, BCBSWY conducts participating providers recredentialing at least every three years. In the third year of the credentialing cycle, BCBSWY requests providers complete a recredentialing application that requires providers to update information per URAC accreditation guidelines. Please learn more about recredentialing here 

Telemedicine Services Updated 

Effective Nov. 16, 2022, BCBSWY has updated our telemedicine guidance. Inpatient telemedicine encounters are permitted by remote professional providers. Please see updated guidelines here.  

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

Sign up to Receive New and Improved Provider Update   

The BCBSWY Provider Update Newsletter will be updated soon. Please sign up at BCBSWY.com to continue receiving these revamped updates by Dec. 1. Please note: Only those who have registered in the last 12 months will be carried forward.

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