Claims Editing, Code Policy, Preventive Services & More

Ongoing: Advanced Claims Editing

As part of our ongoing code updates to help Providers prepare for our automated claims review process starting March of 2023, we are sharing diagnosis codes that will help ensure your claims are properly coded. Please note the codes below.

Diagnosis Code Policy

BCBSWY will deny procedures or services received with a primary diagnosis of external causes as the only diagnosis on the claim.

BCBSWY will deny E/M services (excluding normal newborn care) billed with 99381-99412, 99420, 99429 (Preventive medicine services) when reported with an ICD-10 “Z” diagnosis code as the only diagnosis on the claim.

BCBSWY will deny services received with a secondary diagnosis code as the principal or primary diagnosis.

BCBSWY will deny any procedure or service received with an ICD-10-CM sequela (7th character “S”) code billed in the primary, first listed or principal diagnosis position.

Sign up to Receive New and Improved Provider Update

The BCBSWY Provider Update Newsletter is getting a makeover. Please sign up at BCBSWY.com to continue receiving these updates with a fresh new look by Dec. 1. Please note: Only those who have registered in the last 12 months will be carried forward.

Preventive Services Reminder

Preventive services are renewed on a benefit anniversary basis. Please make sure to visit Availity or contact Member Services to check the member’s benefit.

Updated Directory Validation

BCBSWY updated our Directory Validation tool instructions on the Availity Portal. The instructions help facilitate compliance with the No Surprises Act requirements. Please see the guide here.

Prenatal and Postpartum Coding Request

Together, we understand the critical importance of new mothers receiving prenatal and postpartum care for their safety and the health of their newborns. To monitor the maternal health of BCBSWY members, please help us by including all applicable prenatal and postpartum codes for your patients along with the global billing codes. A coding guide is provided here for your convenience. Thank you for your dedication to healthy outcomes and assisting BCBSWY.

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