Medical drug benefit Clinical Criteria updates (December 2019)

On December 18, 2019, and December 23, 2019, the Pharmacy and Therapeutics (P&T) Committee approved Clinical Criteria applicable to the medical drug benefit for Empire BlueCross BlueShield HealthPlus. These policies were developed, revised or reviewed to support clinical coding edits.

 

The Clinical Criteria is publicly available on the provider websites, and the effective dates will be reflected in the Clinical Criteria Web Posting December 2019. Visit Clinical Criteria to search for specific policies.

 

For questions or additional information, use this email.

 

NYE-NU-0203-20 February 2020

 

Title: Update to corrected claims filing guidelines

The Corrected Claims reimbursement policy has been updated. Previously, the corrected claims timely filing standard was the following:

• For participating providers — 90 days from the date of service
• For nonparticipating providers — 15 months from the date of service

 

Effective August 1, 2020 we updated the corrected claims timely filing guidelines for Empire BlueCross BlueShield HealthPlus to follow the standard of 60 days from the date of payment for participating and nonparticipating providers.

 

NYE-NU-0193-20 February 2020