This article is for Provider Central account administrators and users
We’re doing some spring cleaning of Provider Central users that will extend into year-round maintenance. That means we will start routinely deactivating users who haven’t logged in within the previous twelve (12) months. This will help us have accurate lists of users. Starting on June 5, 2020:
As the administrator, please continue to update and maintain all users under your organization’s account. Although we’re implementing this automated “clean up” process, you are still the best person to manage the users on your account. Please help us remove users who should no longer have access to your organization’s account on Provider Central.
We thank you for being a Provider Central administrator!
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This article is for all providers caring for our members
As we near the end of the year, we want to remind you that your annual 1099 tax forms will be sent to the billing address in our system. This will be the same address where we mailed your 2022 1099 form, unless you have subsequently notified us of a change. To update your address, please use the Standardized Provider Information Change Form.
You can find this form by going to Forms>Administrative>Standardized Provider Information Change Form.
We mail 1099 forms at the end of January. Please submit your address changes by December 31, 2023 to ensure they are in our system before the January mailings. This will make sure you have your 1099 in time to submit your 2023 taxes. You cannot request a duplicate 1099 without submitting the Standardized Provider Information Change Form or a new W-9 form.
Thank you for making any necessary changes by December 31!
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AIM Specialty Health and Beacon Health Options have recently joined the Carelon family of companies. Starting March 1, 2023:
As you know, many of our authorization programs are administered by AIM, an independent company.
These services require authorization through Carelon Medical Benefits Management (formerly AIM Specialty Health):
We partner with Beacon Health Options to offer our Recovery, Education, and Access to Community Health (REACH) program to commercial members living in Massachusetts. This discharge case management program is designed to help patients with behavioral health difficulties. Learn more about REACH.
This name change will not impact contact information or level of support that the program offers.
Blue Cross will revise all references on Provider Central over the next several weeks to Carelon Medical Benefits Management and Carelon Behavioral Health.
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This article is for all medical providers, office staff, and billing agencies who use Online Services
All existing Online Services users will need to switch to ConnectCenter by September 30 for all transactions, including real-time eligibility and benefits inquiries, referrals, and claims.
For authorization requests and verification, you will need to use Authorization Manager. In addition, we recommend using Authorization Manager to submit referrals (see Resources section below to learn more).
ConnectCenter is available at no additional cost to you for your Blue Cross Blue Shield patients. You can access ConnectCenter from the Provider Central eTools page without a separate log-on.
With its fresh modern interface, ConnectCenter offers new tools and reports to streamline your work.
For additional help getting started, contact Change Healthcare’s ConnectCenter support at 1-800-527-8133.
Learn more by attending one of our training webinars. Click here to register today!
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July 21, 2022 update: We have postponed the date for Online Services retirement. Read more.
This article is for all medical providers, office staff, and billing agencies who use Online Services
Online Services users will need to switch to ConnectCenter by:
ConnectCenter is available at no additional cost to you for your Blue Cross Blue Shield patients. You can access ConnectCenter from the Provider Central eTools page without a separate log-on. With its fresh modern interface, ConnectCenter offers new tools and reports to streamline your work.
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This article is for acute care hospitals and surgical day care centers caring for our members
Please share with relevant office staff and billing agencies
As you know, we partner with Equian, a national payment integrity vendor, to review select inpatient facility claims on a pre-payment basis. Effective November 4, 2024, Equian will change the mailing addresses that you use to submit necessary information for them to complete their reviews. Their electronic contact information will not be changing.
Please refer to the table below and notify any relevant office staff and billing agencies of this change.
For Equian requests related to |
Contact them at |
And starting November 4, 2024, use these new mailing addresses |
---|---|---|
Itemized bill requests |
Email: mca@equian.com |
USPS mail: Equian - IBR Or UPS/FedEx packages: |
Reconsiderations/appeals |
Email: reconsiderations@equian.com Fax: 1-866-700-5769 |
|
Provider reports |
Email: reconsiderations@equian.com Or |
|
Resolutions |
Email: claimsresolution@equian.com Phone: 1-800-806-9784 |
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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Blue Cross Blue Shield of Massachusetts announced today that Andrew Dreyfus will step down as president and chief executive officer at the end of 2022. The company's Board of Directors will begin a national search for Dreyfus' successor.
During his time with Blue Cross, he led the creation of the Alternative Quality Contract, one of the largest commercial payment reform initiatives in the nation. He also served as founding President of the Blue Cross Blue Shield of Massachusetts Foundation, where he oversaw the development of the “Roadmap to Coverage.” That multi-year initiative led to the passage of the state’s landmark 2006 Health Reform Law, which resulted in the lowest uninsured rate in the country and later became the model for the Affordable Care Act.
"I feel honored to have been part of an organization that cares so deeply about its members and the community," Dreyfus said. "And I feel proud to have collaborated with others to broaden coverage and improve health care quality, equity, and affordability."
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Did you know billing agencies can register for Provider Central to work on behalf of the offices they serve?
Working efficiently with you and your billing agency is important to us. For this reason, we recently developed a new page of Provider Central that’s dedicated to billing agencies. We also offer tips for provider organizations that use billing agencies to share with your biller.
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This article is for all providers caring for our members
If you still receive paper checks from Blue Cross, there’s no better time than now to get your reimbursement faster and more conveniently by direct deposit (also known as electronic funds transfer, or EFT). We offer EFT through Payspan. You can learn more about all the benefits of using Payspan at one of their upcoming webinars.
As a reminder, medical providers—including physicians, clinicians, hospitals, and facilities—are required receive their reimbursement electronically. For dental providers, EFT is our standard method of payment.
Our website offers several quick tutorials and videos to help you understand the benefits of using Payspan and how to get started. To learn more, log in and go to eTools>Payspan.
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This article is for all providers caring for our members
If you still receive paper checks from Blue Cross, there’s no better time than now to get your reimbursement faster and more conveniently by direct deposit (also known as electronic funds transfer, or EFT). We offer EFT through Payspan. You can learn more about all the benefits of using Payspan at one of their upcoming webinars.
As a reminder, medical providers—including physicians, clinicians, hospitals, and facilities—are required receive their reimbursement electronically. For dental providers, EFT is our standard method of payment.
You can view quick tutorials and videos to understand the benefits of using Payspan and how to get started on our eTools page.
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This article is for all medical providers, office staff, and billing services that use Online Services
Are you prepared to use ConnectCenter for real time transactions (eligibility and claim status)? As a reminder, Online Services will be retired on September 30. If you haven't made the switch, we still have nine more training sessions scheduled in the coming weeks. You can learn about the most relevant functions for you:
Register for a webinar today!
If you’ve already attended a training but would like to refresh your understanding of specific topics, our ConnectCenter page now features brief (under 15 minutes) videos highlighting many different features of this eTool.
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This article is for providers who perform ABA services
As a reminder, all providers will be required to submit authorization requests and inquiries electronically rather than by phone or fax starting June 1, 2023 for our commercial (HMO, PPO) and Federal Employee Program (FEP) members. The most efficient method is to use Authorization Manager, available 24/7 at no additional cost, via single sign-on through Provider Central.
Note: In Authorization Manager, one unit equals 15 minutes.
Watch this short video demonstrating the step-by-step process of how to submit a request for ABA services in Authorization Manager.
Did you know that you can already start using Authorization Manager today? It’s the most efficient way to review authorization requirements, request authorizations, check existing case status, and view or print the decision letter. This tool allows you to:
To read our News Alert announcing this upcoming mandate, log on to bluecrossma.com/provider and click News. Scroll down to the February 1 communication: “Submit referrals, authorization requests, and inquiries electronically starting June 1.”
Read our News Alert announcing this upcoming mandate: “Submit referrals, authorization requests, and inquiries electronically starting June 1."
Please send an email to us at hmmauthorizationmanager@bcbsma.com with any questions you may have about Authorization Manager.
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This article is for all providers caring for our members
We recently created a detailed Brainshark presentation that focuses on helpful tips for billing agencies. This resource can also be useful for providers who use billing agencies.
The presentation highlights:
If your organization uses a billing agency, please share our Brainshark with them.
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This article is for providers who perform Assisted Reproductive Technology services
As a reminder, all providers will be required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax starting June 1, 2023 for our commercial (HMO, PPO) and Federal Employee Program (FEP) members. Authorization Manager is the most efficient method to submit requests, and it’s available 24/7 at no additional cost via single sign-on through Provider Central!
Here are some tips specifically for providers who perform Assisted Reproductive Technology (ART) or early pregnancy monitoring (EPM) services:
Why wait? Start using Authorization Manager today to review authorization requirements, request authorizations, check existing case status, and view or print the decision letter. This tool also allows you to:
To read our News Alert announcing this upcoming mandate, log in to bluecrossma.com/provider and click News. Scroll down to the February 1 communication: “Submit referrals, authorization requests, and inquiries electronically starting June 1.”
We’re here to help. Please send an email to us at hmmauthorizationmanager@bcbsma.com with any questions you may have about Authorization Manager.
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This article is for all mental health providers caring for our members
As a reminder, all providers will be required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax starting June 1, 2023 for our commercial (HMO, PPO) and Federal Employee Program (FEP) members. Authorization Manager is the most efficient method to submit requests, and it’s available 24/7 at no additional cost via single sign-on through Provider Central!
Both medical and mental health providers will need to use Authorization Manager starting June 1. Here are some tips specifically for mental health providers:
Why wait? Start using Authorization Manager today to review authorization requirements, request authorizations, check existing case status, and view or print the decision letter. This tool also allows you to:
To read our News Alert announcing this upcoming mandate, log on to bluecrossma.com/provider and click News. Scroll down to the February 1 communication: “Submit referrals, authorization requests, and inquiries electronically starting June 1.”
Read our News Alert announcing this upcoming mandate: “Submit referrals, authorization requests, and inquiries electronically starting June 1.”
Please send an email to us at hmmauthorizationmanager@bcbsma.com with any questions you may have about Authorization Manager.
This article is for all providers (except dentists) caring for our members
February 3, 2021 update: We’ve posted links to resources, including slides for the webinar presentation and quick tips.
Effective Monday, February 15, 2021, Authorization Manager, our enhanced utilization management tool, will go live.
Effective Monday, February 15, 2021, Authorization Manager, our enhanced utilization management tool, will go live. If you aren’t currently a registered Provider Central user, please register now to take advantage. Here’s how: Provider Central Registration.
Mark your calendar! We’re hosting an hour-long webinar on Thursday, February 4, 2021 from noon to 1 p.m. to show you how to use Authorization Manager’s newest features. Our Blue Cross experts will cover these topics and allow time for questions:
Attending the webinar
Please register for the session so we know how many will attend.
On February 4 at noon, join the webinar. Paste this link into your web browser: https://primetime.bluejeans.com/a2m/live-event/cxeectjd
Authorization Manager will make it easier for you to manage your authorizations and referrals for all of our members*. It builds on the authorization management system we launched last year for Medicare Advantage members.
This tool will allow you to submit authorization requests for a greater range of services than you can submit through Online Services. You will be able to submit and view authorization requests when it’s convenient for you, allowing you to rely less on phone and fax. It is available 24 hours a day, 7 days a week, from the office or when working remotely.
*Blue Cross Blue Shield of Massachusetts members who have selected a Massachusetts primary care provider.
At Blue Cross, we are working to become fully digital and shifting all of our prior authorization requests from fax and phone to Authorization Manager. We’ve seen during the pandemic how critical digital tools are to facilitating your transactions in a timely manner, and ultimately in supporting our members.
Authorization Manager provides an alternative to Online Services that will allow you to:
You should continue using your current process to submit authorizations for oral surgery and for medications.
In the meantime, if you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to your patients—our members.
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This article is for all providers (except dentists) caring for our members
Authorization Manager, launched on February 15, 2021, has been up and running for eight weeks. We strongly urge you to use this tool. It will help streamline your authorization requests.
To access all authorizations for your organization, be sure all of your Blue Cross Blue Shield of Massachusetts provider numbers are registered in Provider Central.
We have many tools available for you, including:
We also can offer a one-on-one phone conversation with one of our experts. To schedule one, send an email to ClinicalIntakeSupervisorMailbox@BCBSMA.com.
As always, thank you for the care you provide to your patients—our members.
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This article is intended for physicians, clinicians, and other providers who order clinical laboratory services for our members
Please remember when referring our members for medically necessary clinical laboratory services, you should make your best efforts to use providers who participate in our networks.
We've noticed an increase in claims submitted by non-participating laboratories such as AccuReference Medical Lab. AccuReference is not a contracted clinical laboratory.
Using a participating laboratory helps reduce health care costs in general and for your patients specifically.
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to your patients—our members—and for your efforts to refer in our networks.
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This article is for behavioral health practitioners caring for our members and their office staff
November 6, 2020 update: We’ve posted a link to the recorded webinar, a copy of the slides, and answers to questions received during the presentation. Refer to the links below.
Mark your calendar! We’re hosting a webinar designed for behavioral health providers on Wednesday, October 28, 2020 from 11 a.m. — noon. Our Blue Cross experts will cover these topics and allow time for questions:
If you can’t attend on October 28, we’ll post a recording to this news article within a week of the session (by November 4).
We hope this webinar provides you with information you need to support your patients—our members.
Other resources
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This article is for dentists caring for our members
Dental Connect is an online portal where our participating dental providers can access eligibility, benefit, and claims information. You can use the portal to view patient claim history by procedure code, search benefits by CDT code or service category, and view members’ remaining deductibles. Using Dental Connect can help you to save time on the phone and to spend more time caring for your patients.
Here are some steps to take to get started with Dental Connect.
Go to Dental Connect and create an account using your corporate NPI and practice tax ID. Be sure to use partner code BCMA01DPS when prompted during registration. You can also access Dental Connect from our eTools page.
After completing your practice profile, you will be asked to verify the tax ID associated with your account. To register for Dental Connect, you’ll need to verify the tax ID associated with your practice. As part of this process, you must provide two claim examples. Note: It is important that you enter the claim data exactly as it appears on your Provider Detail Advisory.
If you encounter problems verifying your tax ID, you can download the Tax ID Verification form shown above and mail or fax it to Change Healthcare for processing. They will respond by email in two to four business days to let you know that verification is complete and that the account is active.
You only need to provide information from one provider in your practice in the Rendering Provider Information section to validate the tax ID. Note: you must use the form if your practice uses a clearinghouse other than Change Healthcare or if your practice submits paper claims.
Now that you have registered for your Dental Connect account, here are some tips for successful navigation to save you time:
For technical support with Dental Connect, please contact Change Healthcare directly at
1-866-777-0713.
If you have any other questions, please call Dental Network Management at 1-800-882-1178.
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This article is for all providers caring for our members
As you know, the realities of working in health care can drive professionals to face burnout and mental health challenges. Many health care professionals are confronted with excessive workloads and administrative burdens, all while managing their patient care throughout a worldwide pandemic.
If you are feeling burned out or feel you could use support, the Betsy Lehman Center for Patient Safety can help.
The Center has created a Virtual Peer Support Network available for free to Massachusetts’ medical community, including physicians, nurses, pharmacists, laboratory and radiologic technologists, public safety officers, environmental services, office staff, and more. Interactions are one-on-one, with a professional in a similar role, outside of your organization. All communication is confidential.
"This program can help bridge gaps among all health professionals; we’re all in this together. You never know how a shared experience can help one of your peers cope with the kind of stressful situations that are happening every day. Talking it through can help you learn how to better manage those day-to-day struggles.”
– Dr. Ben Kruskal, Medical Director for Clinical Integration, Health & Medical Management at Blue Cross Blue Shield of Massachusetts
If you’d like to request a peer supporter:
Being on the frontline isn’t easy, so we thank you for all that you do in providing care to those that need it most.
This article is for all providers caring for our members
Dr. Karl Laskowski,
Vice President and Medical Officer
Blue Cross Blue Shield of Massachusetts is excited to welcome Dr. Karl Laskowski as vice president and medical director of clinical programs and strategy.
Dr. Laskowski joins Blue Cross from Brigham Health/Brigham and Women's Hospital (BWH), where he served as associate chief medical officer, as well as a practicing physician and an instructor in medicine for Harvard Medical School. He continues to care for patients at BWH part-time.
"Karl's deep experience introducing innovation into clinical practice will be instrumental in developing new approaches that ensure our members get the right care, at the right time, in the right setting. This will help us to achieve our vision of being our members' trusted ally," said Dr. Sandhya Rao, chief medical officer and senior vice president at Blue Cross.
Dr. Laskowski received his MD and his Master of Health Science from Yale University School of Medicine, and he completed his residency at Brigham and Women's Hospital. He earned his MBA from Harvard Business School.
For more details, read our press release.
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This article is for dentists caring for our members
Our simple CDT Lookup tool can help you quickly find the procedure guidelines and submission requirements for CDT codes online instead of calling Dental Provider Services. We recently added the ADA category for each code to help you better understand coverage.
The CDT lookup tool provides customized information based on the member’s plan.
If you'd prefer to download a PDF version of the CDT and Pediatric Essential Health Benefits guides, you can download them from our Provider Manuals page.
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This article is for dentists and oral surgeons caring for our members
Our simple CDT dental procedure code lookup tool can help you quickly find the procedure guidelines and submission requirements for CDT codes online rather than by calling Dental Provider Services.
Using this tool can save you time. And, if you use a third-party vendor to perform this research, asking them to use the online tool may reduce the time they wait in our phone queues.
The tool allows any user in your practice to access code information based on our standard plan offerings. The three-minute video on the CDT dental procedure code lookup tool page shows you just how quick and simple it is to find out the information you need.
If you prefer, you may also download the electronic versions of the CDT and Pediatric Essential Health Benefits guides quickly and conveniently to your desktop. They can be found on the Billing Guidelines & Resources page of Provider Central.
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Our simple CDT Lookup tool can help you quickly find the procedure guidelines and submission requirements for CDT codes online rather than by calling Dental Provider Services. We recently added the dental procedure category for each code to help you quickly assess how much coverage your patients may have.
The CDT lookup tool lets you customize the response based on the member’s plan.
If you prefer a PDF version of the CDT and Pediatric Essential Health Benefits guides, you can download these guides from the Billing Guidelines Resources page of Provider Central.
If you prefer a PDF version of the CDT and Pediatric Essential Health Benefits guides, you can download these guides from the Billing Guidelines & Resources page of Provider Central.
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All providers caring for our members
We recently added the following updates to our COVID-19 Information page for providers. For complete details, visit the page and look at content under the categories noted in bold below.
Per state mandate, Chapter 260 of the Acts of 2020 – Patients First Act, cognitive rehabilitation for cognitive impairment resulting from COVID-19 is covered in the outpatient setting.
PCR or antigen testing to detect SARS-CoV-2 is not covered for over-the-counter at-home COVID test kits. (Only provider-ordered, medically necessary tests are covered.)
We added the following codes that were effective January 1, 2021. Find the complete list on our COVID-19 Information page.
If patient is | Please use | Definition |
---|---|---|
Symptomatic or has been exposed to COVID-19 | Z11.52 | Encounter for screening for COVID-19 (Effective January 1, 2021) |
Z20.822 | Contact with and (suspected) exposure to COVID-19 (Effective January 1, 2021) |
Diagnosis code | Service description |
---|---|
J12.82 | Pneumonia due to COVID-19 (Effective January 1, 2021) |
M35.81 | Multisystem inflammatory syndrome (Effective January 1, 2021) |
M35.89 | Other specified systemic involvement of connective tissue (Effective January 1, 2021) |
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This article is for all Blue Cross Blue Shield of Massachusetts providers except dental
We’d like to communicate these three things:
We have developed a temporary COVID-19 payment policy to remain in effect during the Massachusetts public health state of emergency.
This new temporary policy includes a collection of policy updates that outlines how Blue Cross reimburses for COVID-19 related services, with guidance from the Centers for Disease Control, the Centers for Medicare & Medicaid Services, state health departments, the American Medical Association, and other relevant health organizations.
Information in this temporary COVID-19 payment policy supersedes all other Blue Cross payment policies for the duration of the Massachusetts emergency.
Because this situation is fluid and fast-moving, we will continue to update the policy as things change. Please refer to the “Policy Update History” on the last page of the COVID-19 payment policy to learn more about the most recent updates. We’ll also share updates in our weekly COVID-19 email.
What’s included in this new policy?
The Centers for Medicare & Medicaid Services created two new HCPCS codes for COVID-19 lab testing. These codes are included in the COVID-19 payment policy and will be added to the applicable provider fee schedules for all products.
Code | Service description | Reimbursement effective date |
---|---|---|
U0003 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) (Coronavirus disease [COVID-19]), amplified probe technique | For dates of service on or after April 14, 2020 |
U0004 | 2019-NCOV Coronavirus, SARS-COV-2/2019-NCOV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC |
Fee schedules will be updated
We will update our professional, hospital outpatient, and clinical laboratory fee schedules accordingly.
We’ve received calls from members who have been charged a cost share (copayments, co-insurance, and deductibles) for their telehealth or telephonic visit because the services were not billed with a modifier. Since we removed member cost share for all telehealth services (both COVID-19 and non-COVID-19-related) for in-network providers, the member should not be charged anything for telehealth or telephonic visits.
These services include:
Exception: For FEP, applicable cost share applies for all non-COVID-19 services provided by a non-Teladoc provider.
Use modifiers and place of service when applicable
Please review our COVID-19 payment policy to make sure you are including the correct modifiers and place of service on your claims, when applicable.
Replacement claims
If you’ve submitted claims for telehealth or telephonic visits with dates of service between March 16, 2020 and today, and there’s a patient liability (cost share) that you think may have been applied incorrectly due to the way you billed, do not submit a new claim. Instead:
See our replacement claims page for more information.
Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).
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All providers caring for our members
We understand that this is a trying time for all medical care providers due to COVID-19. To better support you, we’ll continue to waive referral and prior authorization requirements for all inpatient levels of care. This includes acute, long-term acute (LTAC), acute and subacute rehabilitation (rehab), and skilled nursing facility (SNF) admissions. Starting with dates of service on or after October 1, 2020, you will need to submit authorizations.
FEP is following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. For more details see fepblue.org. This is in place for the duration of the state of emergency.
What this means
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This article is for all providers caring for our members
Updated August 31, 2020 to add convalescent plasma as having received EUA approval for use in COVID-19 treatment.
Blue Cross Blue Shield of Massachusetts follows federal and state mandated requirements for SARS CoV-2 (COVID-19) treatment coverage. This article clarifies:
FDA/EUA approved pharmaceutical treatments for COVID-19 infection
Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to the member throughout the duration of the public health emergency.
To date, there are no FDA-approved drugs for COVID-19. However, Remdesivir has received emergency utilization approval (EUA) for patients in an inpatient hospital setting who require treatment beyond respiratory support; and convalescent plasma has received emergency utilization approval (EUA) for hospitalized patients.
Drugs under investigation for COVID-19 infection
Drugs that are covered
Several drugs are under investigation through clinical trials as potential treatments for COVID-19 that have shown early benefit. Blue Cross Blue Shield of Massachusetts covers the following drugs when used outside a clinical trial for patients who are in an inpatient hospital setting and require treatment beyond respiratory support, at the discretion of their treating provider:
Please note that standard inpatient payment policy rules apply.
Drugs that are not covered
Blue Cross Blue Shield of Massachusetts does not cover drugs under investigation through clinical trials that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by CDC, NIH, or DPH guidelines.
The following drugs are not covered outside of the clinical trial setting:
Viral testing
Coverage for Medicare Advantage patients in an inpatient hospital setting who require treatment beyond respiratory support is covered under Medicare Part A and follows CMS guidelines. For more information, see this CMS press release on New Hospital Procedure Codes for Therapeutics in Response to the COVID-19 Public Health Emergency
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Update issued: April 21, 2020
We have added a clarification to the “Provider audits and claim reviews on hold” section.
This article is for all Blue Cross Blue Shield of Massachusetts professional providers (except dental)
In support of Governor Baker’s public health emergency order to expand access to physician services, we have developed an expedited, time-limited Public Health Emergency Provider Credentialing and Enrollment Process effective immediately.
Fill out our Public Health Emergency Credentialing Application (PHE App) and have an authorized representative of the group you are joining sign and send it back to PHEexpeditedCred@BCBSMA.com. You do not need to complete the Health Care Administrative Solutions (HCAS) enrollment form.
Provider audits and claim reviews on hold
Effective immediately, Blue Cross will be pausing all provider audit and claim review activities for the next 60 days, or for the duration of the state of emergency (whichever comes first). This pause will include activities related to all:
Please note that we will continue to evaluate paid claims for duplicate payments as well as Coordination of Benefits and Subrogation. Blue Cross also continues to conduct medical reviews and claim recovery activities if there is an indication of potential fraud.
If you have any questions about this process, please contact your Network Manager or Provider Service at:
1-800-882-2060 (Physicians)
1-800-451-8123 (Hospitals)
1-800-451-8124 (Ancillary Providers)
We value our partnership with you, and we will do everything we can to support you as you care for your patients—our members—under these extraordinary circumstances. Thank you for all you do.
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This article is for all acute care and other hospitals and facilities providing inpatient levels of care to our members
Updated October 22, 2020 to add authorization requirements by service requested and product, including if notification or medical necessity review is required. See table at the end of the article for details.
In June, we announced that we would waive authorization requirements associated with certain inpatient levels of care.
Recognizing that some inpatient acute care hospitals continue to have administrative resource issues due to COVID-19, we will extend our waiving of authorization requirements at inpatient acute care and mental health hospitals for dates of service on or before December 31, 2020. This applies to:
Through dates of service up to and including December 31, 2020, inpatient acute care hospitals and mental health hospitals must notify us of inpatient admissions. Timely notification serves to facilitate care coordination, mobilize additional services to support transition-of-care, and facilitate discharge planning. While this notification-only requirement is in place, we will not perform medical necessity reviews.
Starting with dates of service on or after January 1, 2021, authorization requirements will be reinstated. You will need to submit requests and supporting documentation for prior authorization at that time.
Consistent with what we announced in June, starting on October 1, 2020 we are resuming referral and prior authorization requirements for all other inpatient levels of care for commercial products (all products except FEP and Medicare). This includes long-term acute care (LTAC) hospitals, acute and subacute rehabilitation (rehab) facilities, and skilled nursing facility (SNF) admissions.
Authorization requirements by service and product
Effective October 1, 2020 for dates of service through December 31, 2020
Definitions
Notification only required | Does not require submission of clinical documentation for initial admission or concurrent review |
Medical necessity review required | Requires that the requesting provider submit clinical documentation in support of the request |
Authorization requirements
Level of care or service | Commercial HMO, Indemnity and PPO | Medicare Advantage | FEP |
---|---|---|---|
Behavioral health – inpatient | Notification only required | ||
Behavioral health – acute residential treatment (partial hospitalization & intensive outpatient program) | Medical necessity review required | ||
Emergent inpatient | Notification only required | ||
Preservice inpatient | Notification only required (for dates of service through December 31, 2020) | ||
Skilled nursing facility, rehabilitation, and long-term acute care hospitals Benefit limits still apply |
Medical necessity review required | Notification only required | Medical necessity review required |
Home health care Benefit limits still apply |
Medical necessity review required | HMO Notification only required PPO |
No notification required |
Other previously approved elective surgeries | Extended authorizations to be valid through December 31, 2020 | ||
Previously approved behavioral health testing (example: neuropsychological testing) |
Extended authorizations to be valid through December 31, 2020 |
For more information, please refer to our Authorization Quick Tip.
Thank you for the care you provide to your patients—our members.
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We have extended our waiver for prior authorizations. Starting with dates of service on or after October 1, 2020, you will need to submit authorizations. Learn more.
We have added information previously found on the Federal Employee Program (FEP) website about member cost share FEP members.
Update issued: Apr 14, 2020This article is for all Blue Cross Blue Shield of Massachusetts providers (except dental)
|
We are closely monitoring the coronavirus (COVID-19). Because this situation is fluid and fast-moving, we will publish the latest information on our COVID-19 Information page for our health care partners. Please check this page often for the latest updates.
Blue Cross Blue Shield of Massachusetts values our partnership with you, and we will do everything we can to support you as you care for your patients—our members—during this time. We are following the Centers for Disease Control’s (CDC) Prevention guidelines along with Governor Baker’s emergency order and federal mandates and will continue to support and protect the health and well-being of members and the community.
New codes were recently announced for providers and laboratories to test patients for COVID-19. These codes will apply to all commercial, Federal Employee Program (FEP), and Medicare Advantage members. For FEP coverage guidelines, see information below.
Code | Service description | Reimbursement effective date |
---|---|---|
U0001 (HCPCS) |
CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel | Effective April 1, 2020 for dates of service on or after February 4, 2020 |
U0002 (HCPCS) |
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC | |
87635 (CPT) |
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique | Effective March 13, 2020 |
We have updated our Laboratory and Pathology payment policy to reflect these codes.
We will update ancillary and behavioral health fee schedules accordingly.
We have updated our Laboratory and Pathology payment policy to reflect these codes.
We will update ancillary and behavioral health fee schedules accordingly. To see your fee schedule, log in and go to Office Resources>Billing & Reimbursement>Fee Schedules.
Use the diagnosis codes below for patients presenting for evaluation of suspected COVID-19.
In accordance with CDC and Department of Public Health DPH guidelines, we expect providers to code for COVID-19 testing and treatment, including supportive services for symptoms related to COVID-19 at doctor’s offices, emergency rooms, and urgent care centers. Blue Cross will identify patients presenting for evaluation of possible COVID-19 using the below codes:
Diagnosis code* | Service description |
---|---|
Z20.828 | Contact with and (suspected) exposure to other viral communicable diseases |
Z03.818 | Encounter for observation for suspected exposure to other biological agents ruled out |
Z11.59 | Encounter for screening for other viral diseases |
If your patient has a previously confirmed COVID-19 illness or tests positive for COVID-19, use the codes below.
Diagnosis code* | Service description |
---|---|
B97.29 |
Other coronavirus as the cause of diseases classified elsewhere |
B97.21 | SARS-associated coronavirus as the cause of diseases classified elsewhere |
U07.1 | 2019-nCOV acute respiratory disease (effective April 1, 2020) |
B34.2 | Coronavirus infection, unspecified |
*The CDC has created an interim set of ICD-10 CM official coding guidelines, effective February 20, 2020.
We are removing all member cost share (copayments, co-insurance, and deductibles) for a telephone (telephonic) call in place of an office visit, and a virtual/video appointment (telehealth) services for all COVID-19 and non-COVID-19-related services for in-network providers. This is in place for the duration of the Massachusetts state of emergency.
For in-person doctor, urgent care and emergency room visits related to the testing, counseling, vaccination, and treatment of COVID-19, we are removing all member cost share. This is in place for the duration of the Massachusetts state of emergency.
For medically necessary inpatient acute care hospital services, we are waiving member cost share when the claim includes a diagnosis of COVID-19. Read our April 7 news article.
Member cost share will also be removed for inpatient acute care hospitals, inpatient rehab facilities, long term acute care hospitals, and skilled nursing facilities for services related to COVID-19.
We’ve removed the member cost share for all telehealth services (COVID-19 and non-COVID-19-related) received through the Teladoc network. Members can register for Teladoc by visiting fepblue.org/coronavirus. For other providers offering telehealth services, the applicable cost share will apply (unless COVID-19 related).
FEP will determine coverage for the vaccine once it becomes available.
Effective for dates of service retroactive to March 16, 2020, all in-network providers may deliver all medically necessary covered services (COVID-19 AND non-COVID-19 related) via any modality. This includes telehealth (video), telephonic (audio) or in-person to all Blue Cross Blue Shield of Massachusetts members. We will reimburse at the same rate as an in-person visit for all provider specialties, including ancillary. This is in place for the duration of the Massachusetts state of emergency.
You can offer telehealth services as long as you are contracted and credentialed by Blue Cross Blue Shield of Massachusetts. There are no additional credentialing or contracting processes you need to follow to offer telehealth services.
The U.S. Department of Health and Human Services and the Office of Civil Rights have relaxed HIPAA requirements related to the use of telehealth services during the COVID-19 nationwide public health emergency. See the Notification of Enforcement Discretion for telehealth.
Starting immediately, Blue Cross will cover visits through telehealth or by telephone (“telephonic visits”). Follow the telehealth billing guidelines to bill for telehealth services the same as you would as in-person and include the following modifiers with place of service 02:
Bill for telephonic services using the telephonic CPT codes as indicated in the telehealth billing guidelines with place of service 02.
The billing guidelines are included in the following payment policies:
Telehealth (Telemedicine) Medical payment policy
Telehealth (Telemedicine) Behavioral Health payment policy
Telehealth (Telemedicine) Medical payment policy
Telehealth (Telemedicine) Behavioral Health payment policy
Important note: This information only applies to the ancillary and behavioral health specialties on this list.
Referrals and prior authorizations are not required for medically appropriate care for COVID-19.
We are lifting limits on early refills of prescription medications, allowing members to obtain one additional fill of their existing prescription. This is in place for the duration of the state of emergency.
For COVID-19-related benefit changes impacting the Federal Employee Program, please see fepblue.org/coronavirus.
If your patients have coronavirus benefit questions or would like to speak to a nurse, they can call our dedicated coronavirus help line at 1-888-372-1970.
Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).
Telehealth information
Coronavirus resource center
Laboratory and Pathology payment policy
Telehealth (Telemedicine) Medical payment policy
Telehealth (Telemedicine) Behavioral Health payment policy
Telehealth information
Coronavirus resource center
Laboratory and Pathology payment policy ()
Telehealth (Telemedicine) Medical payment policy ()
Telehealth (Telemedicine) Behavioral Health payment policy ()
MPC_030620-1N-5
This article is for all providers caring for our members
On April 8, 2020, we notified you that we were pausing the following activities for 60 days or until the end of the public health emergency, whichever came first. Effective immediately we will resume these activities:
Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).
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This article is for medical providers who use Online Services
Online Services (Change Healthcare) is updating its claim status functionality in the next few weeks. The "Additional Information" link will no longer be available (see image below).
You’ll still be able to get information about claims we’ve processed by viewing your payment advisories (Provider Detail Advisory and Provider Payment Advisory) in Payspan.
Video on how to research payment advisories in Payspan
Claim submission information
Payspan quick start guide
MPC_111819-1P-2
This article is for Online Services users.
The “family search” functionality currently available through Online Services allows users to perform an eligibility search using only the Blue Cross Blue Shield of Massachusetts member ID.
On September 1, 2020, we’re removing the family search option from Online Services because it will no longer be supported by underlying technology. You still will have a number of ways of finding members in Online Services.
If you | Then you can search in Online Services by: | Examples: |
---|---|---|
Have the member’s ID number | Member ID number, plus any one of the following:
|
|
Don’t have the member’s ID number | Member’s first and last name plus member’s date of birth. |
|
Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).
MPC_060220-2Q-1
July 21, 2022 update: We have postponed the date for Online Services retirement. Read more.
This article is for physical therapists, occupational therapists, speech therapists, and coordinated home healthcare providers caring for our members
Reminder: we will retire Online Services on August 12, 2022.
Because you must submit an authorization request—not a referral—for outpatient rehabilitation and home health care, you must begin using Authorization Manager for these services by August 12. In the Request Type menu, select “Service Request” for all outpatient medical requests.
For other transactions, including benefit and eligibility inquiries, you can use ConnectCenter.
The following guides and video demonstrations are available on our Authorization Manager page:
MPC_062321-2L-74-ART
This article is for all providers (excluding dentists) caring for our members
To help us share our claims decision-making criteria with you as soon as we make updates, we have changed the way you access InterQual® criteria on our website. The Level of Care Criteria Application (also called the InterQual Transparency Tool) on the page is now hosted by Change Healthcare.
We also use InterQual criteria for select surgical procedures such as spine, hysterectomies, and hip and knee replacements.
In addition, we moved the InterQual Criteria & SmartSheet page to the Clinical Resources>Coverage Criteria and Guidelines section on our website.
To access the Transparency Tool, log in and go to Clinical Resources>Coverage Criteria and Guidelines>InterQual Criteria & SmartSheets. Then click Go Now.
Note: You must enable cookies on your browser.
To view, download, or print InterQual criteria:
The criteria included in the Transparency Tool appear in these Change Healthcare products:
Medical/surgical products | Behavioral health products |
---|---|
LOC: Acute Adult LOC: Acute Pediatric LOC: Long-Term Acute Care LOC: Rehabilitation LOC: Subacute/SNF LOC: Home Care Q&A LOC: Outpatient Rehabilitation* CP: Procedures |
BH: Adult and Geriatric Psychiatry BH: Child and Adolescent Psychiatry BH: Procedures Q & A BH: Substance Use Disorders |
* excluding chiropractic
MPC_021821-3E-1
This article is for all providers caring for our members
As new employer groups join Blue Cross Blue Shield of Massachusetts, we issue their employees new Blue Cross member ID cards. However, some members may not receive their new ID cards until after January 1, 2024.
If Blue Cross patients visit your office without an ID card, please check their benefits and eligibility before providing services, by using an online tool such as ConnectCenter. For members of Blue Cross Blue Shield of Massachusetts plans, you can look up their benefits using their full name and date of birth.
ConnectCenter Quick Start Guide
MPC_121923-2C
This article is for acupuncturists caring for our members
As you may know, we launched acupuncture benefits for our members beginning in January 2020. The benefits are phased in throughout the year as the member’s employer renews their coverage with Blue Cross. This means that during 2020 we’ll have some members who are not eligible for the benefits because their account hasn’t yet renewed their coverage for the plan year. In addition, some employer groups will exclude acupuncture coverage all together.
To confirm a member’s plan has an acupuncture benefit available, you will need to perform an eligibility inquiry for ‘acupuncture’ services and verify the plan renewal date. Until a member becomes eligible for the acupuncture benefit, our online benefits system, shown below, will not display accurate information about whether the member has coverage.
Ask the member to call Member Service to determine when their account renewal date is to find out when their acupuncture benefits are available.
The screenshot below shows what an eligibility query looks like when a member does not yet have active coverage for acupuncture.
We recently became aware of a system problem causing acupuncture claims to deny due to lack of a referral. No referral is required. We have fixed the problem and we are reprocessing any claims that may have rejected because of this mistake. We apologize for this error.
MPC_022120-1G-1
This article is for chiropractors.
By mid-June, chiropractors will receive their annual performance reports. The report compares care you provide to that of your peers and can be a useful tool in understanding your practice patterns.
The independent company that administers our chiropractic authorization program,
WholeHealth Networks, Inc., a Tivity Health company, developed these and will be mailing them. If you have questions about your report, you can call WholeHealth Networks at
1-866-656-6071.
Learn more about the chiropractic authorization program
You can get information about members included in the chiropractic authorization program, learn how to request authorization, and more on our Chiropractic Services page.
MPC_021420-2F-2
This article is for chiropractors.
This June, chiropractors will receive their annual performance reports. The report compares care you provide to that of your peers and can be a useful tool in understanding your practice patterns.
The independent company that administers our chiropractic authorization program, WholeHealth Living, Inc., a Tivity Health company, developed these and will be mailing them. If you have questions about your report, you can call WholeHealth Living at 1-866-656-6071.
You can get information about members included in the chiropractic authorization program, learn how to request authorization, and more on our Chiropractic Services page.
MPC_053023-1S-3
This article is for chiropractors.
This month, chiropractors will receive their annual performance reports. The report compares care you provide to that of your peers and can be a useful tool in understanding your practice patterns.
The independent company that administers our chiropractic authorization program, WholeHealth Living, Inc., a Tivity Health company, developed these and will be mailing them in the middle of June. If you have questions about your report, you can call WholeHealth Living at 1-866-656-6071.
Refer to our Chiropractic Services page for information about members included in the chiropractic authorization program, how to request authorization, and more.
Thank you for the care you provide to your patients—our members.
MPC_052824-1F-3
This article is for dentists and oral surgeons caring for our members
We want to continue to guide you on the most efficient way to conduct business with us during the Change Healthcare outage.
Please consider using an alternative electronic clearinghouse for routine eligibility and benefits queries, so that our Dental Provider Services team can continue to assist you with more complicated issues.
While there are a number of clearinghouses that you may consider, DentalXChange and Vyne Dental focus solely on dental provider transactions. Both offer the ability to check eligibility and benefits and to include electronic attachments.
Change Healthcare’s goal is to bring their capabilities online as quickly as possible. We will not reconnect to Change Healthcare’s systems until we conduct rigorous security and risk assessment to protect our systems, and our member and provider data.
For the most up-to-date information, see our Change Healthcare event page.
MPC_022224-1J-15
July 21, 2022 update: We have postponed the date for Online Services retirement. Read more.
This article is for all medical providers, office staff, and billing agencies who use Online Services to submit 1500 claims for our members using Direct Data Entry
If you currently use Online Services to submit 1500 claims using Direct Data Entry, you will need to begin using ConnectCenter by July 22. Online Services will be retired for all transactions on August 12.
We offer a number of resources to help you begin using ConnectCenter.
Many other resources to help you get started with ConnectCenter are available on our ConnectCenter eTools page.
Submitting claims in ConnectCenter allows you to take advantage of new claim tracking features. The benefits of ConnectCenter include:
Claims submitted using Online Services will be harder to track after August 12. Learn about how you can access Online Services claims on page two of our 1500 Claim Entry Quick Tip.
Please note: If you currently receive reimbursement through PaySpan, you’ll continue to use PaySpan for online Provider Payment and Provider Detail Advisories. The transition to ConnectCenter does not impact your use of Payspan.
MPC_062321-2L-58-ART
This article is for all providers caring for our members
Since May 2020 we’ve been emailing our members relevant health and benefits information to help support them during this public health crisis. As a result, members may contact you to schedule appointments to discuss their health.
Our first email this month emphasizes the importance of members taking care of their health by scheduling a routine health checkup and other preventive services. We’ve also recently published a related News Article on Provider Central: Vaccines: Encouraging your patients to stay current.
In mid-July our focus was on expanded access to dental benefits during the Massachusetts health emergency.
In early July, we sent some members general mental health resources. And for those members who are eligible, we featured our new, no-cost online mental health tool, "Learn to Live," that is available when they log in to our MyBlue member website. Learn to Live is a 7-minute, judgement-free way to help members assess and explore their feelings, thoughts, emotions, and mind. Members can use the tool as often as they like, tapping into programs on:
Our earlier Coronavirus member emails focused on:
Each email we send to members also features links to in-depth health stories from Blue Cross’ own health news website, Coverage.
MPC_080320-1Y
This article is for dentists and oral surgeons caring for our members
Meet the Dental Network team (L-R): Jill Gibbons, Sidonnie Parara, David Brow, Kathleen O’Brien, John Basile, and Kevin Klein.
Our Dental Network Management team enjoyed meeting all the dentists, clinicians, and office staff who attended the Yankee Dental conference in January. Our team members spoke with over 1400 providers during the course of the conference!
If you weren’t able to attend – or if you have more questions or concerns – your Dental Network Manager is available to connect with you in your office or by Zoom. Please feel free to call your representative by calling:
1-800-882-1178, option 4 then selecting the appropriate region:
Four lucky attendees who stopped by our booth won an iPad in our raffle. Congratulations to:
Gloria Hui from Quincy Orthodontics | Julie Ringdahl from the office of Janis Moriarty, DMD | Lauren Hennessey from the office of Monica Rao, DMD | Marie Similien from the office of Mary C. Demello, DMD |
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We’ve recently delivered Apple iPads® to the dentists and administrators who won them in our Yankee Dental drawing:
Wendy Dipietro, Cape Cod Dentistry, Hyannis |
Lisa Gately, Tufts Dental School, Boston |
Dr. Jeyasri Gunarajasingam, Dental Health International, Chelsea |
Julie Riendeau, Paxton Dental Care, Paxton |
We look forward to seeing you next year at Yankee Dental, which will be held from January 28 - January 30, 2021. Please be sure to visit our booth!
If you have any questions about doing business with us, please reach out to the Dental Network Manager who represents your region. We’ll be happy to schedule time to talk with you.
For practices located in | Your Dental Network Manager is |
---|---|
Boston and Metro-West | Patricia Crossen 1-617-246-9498 Patricia.Crossen@bcbsma.com |
Central and Western Massachusetts | Patricia Peters 1-617-246-3027 Patricia.Peters@bcbsma.com |
North Shore and New Hampshire |
Jill Gibbons |
South Shore, Cape Cod, and the Islands |
David Brow |
MPC_031120-1L-2-ART
This article is for providers who currently use Online Services for eligibility and benefits queries
You can use ConnectCenter to check benefits and eligibility for Massachusetts, out-of-state, Federal Employee Program, and international Blue Cross Blue Shield members. The level of detail returned may vary because the responses are returned from the member's Blue plan.
To perform a benefits and eligibility inquiry in ConnectCenter:
Change what is displayed under "Eligibility" by using the Select View and Service Types Returned filters.
Perform an eligibility inquiry using the service type for the services being rendered. Telehealth benefits will be returned in the Message section of your results.
Begin by clicking the Human Readable button in your response.
When the Human Readable View opens, search for the current year and scroll to the match. In the example below, the member’s Service Year is 5/1/2022 – 4/30/2023.
Perform an eligibility inquiry with the correct service type and click Submit. Then choose "Limitation – Quantity" from the Select View menu. Benefit usage information for some service types like Chiropractic or Vision may also appear in the Human Readable View.
MPC_062321-2L-57
July 21, 2022 update: We have postponed the date for Online Services retirement. Read more.
This article is for medical providers, office staff, and billing agencies who perform claim status inquiries in ConnectCenter
Reminder: Online Services will be retired for claim submission on July 22. To help you make the transition to ConnectCenter, here are some tips on how to check the status of your claims using the new portal.
For processed claims, you can also use Payspan to learn the claim number, payment or denial details, and check information.
ConnectCenter Quick Start
1500 Claim Entry with ConnectCenter Quick Tip
Checking Claim Status Quick Tip (includes Payspan information)
MPC_062321-2L-80
Are you confused about which of our provider technologies to use for referrals and authorizations? To help you, we’ve created this handy reference table.
Task | Authorization Manager | ConnectCenter |
---|---|---|
Enter and verify referrals |
|
|
Request and verify (including viewing of correspondence) authorizations |
|
|
Check member benefits and eligibility |
|
|
Check claim status |
|
We encourage you to begin using ConnectCenter and Authorization Manager today for referrals and authorizations. Online Services will no longer be in service after September 30, 2022.
If you currently use Online Services to request authorizations, such as for outpatient rehabilitation or home health care, you’ll need to begin using Authorization Manager for this task.
See our Authorization Manager eTools page to help get started.
As you can see from the chart above, you can enter referrals using either ConnectCenter or Authorization Manager. We recommend using Authorization Manager because it allows you to see both the referring provider and servicing provider. Please note that when using Authorization Manager, you must enter procedure code 99243, as well as a diagnosis. If no diagnosis is available, you may enter general symptoms (R68.89). Then continue as you would with an authorization request.
When entering referrals using ConnectCenter, only the 4 Service Types shown below can be used for our members:
For more information and to compare the eTools, visit our Entering & Verifying Referrals page.
MPC_062321-2L-60
This article is for providers who currently use Online Services for real-time transactions and 1500 claim submission
Every time you check a member’s eligibility status in ConnectCenter, the results are stored in your Eligibility History. Your History can then be used as a patient list – a starting point that helps you save time with claims and real-time transactions.
The Eligibility History page is most useful if you perform eligibility inquiries with the patient’s name (and date of birth) rather than their ID number. Including the patient’s name enables ConnectCenter to populate this information into the History page, making the correct transaction easier to identify.
To access previous eligibility results:
For videos, quick tips, and webinar information, visit our ConnectCenter page and click on "Trainings and resources."
MPC_062321-2L-61
This article is for providers who currently use Online Services for eligibility and benefits queries and claim submission
As you begin to explore ConnectCenter, we want to provide you with some quick knowledge to help you get started. In this article, we’ll focus on Provider Management, which is found under the Admin tab.
The Provider Management area in ConnectCenter allows you to:
Note: If you previously entered claims using Online Services, Change Healthcare has transferred your provider information to ConnectCenter. Please review these records before using them in transactions or claims. It is very important that you do not create duplicate provider records.
Click Save to use the provider information in your transactions.
MPC_062321-2L-46
Please share this information with your staff who perform eligibility and benefit inquiries for your Blue Cross patients
The following ConnectCenter tips have been created for providers who perform eligibility inquiries to find out specific benefit details, such as:
Submit your eligibility inquiry with the most appropriate Service Type. If the member is enrolled in a Blue Cross plan, your results will include the words “Active Coverage” in a green bar. The area under the bar may list categories of coverage. This is the Coverage Status area.
Depending on the member’s plan and product, the Coverage Status area may be detailed or simple.
The example below shows the results for an inquiry using the service type, “Chiropractic.” The Coverage Status area shows that this member is in a PPO plan and has not used chiropractic benefits in their service year.
We can also see, in the Eligibility area, that no authorization is required. Because most PPO plans include authorization requirements for visits 13 and beyond, it’s likely that this member has a benefit limit of 12 visits.
After reviewing the Coverage Status area, scroll to the View Options area. This is where you can change which portion of the plan’s response is displayed under “Eligibility.” For most members, the default view will be Copay.
In the example below, for a Medex member, the selected view is Limitation – Quantity.
Here is an example for a Federal Employee Program member with coverage for 12 chiropractic visits per calendar year. Twelve visits are remaining.
The member below is also in a PPO plan. We can see that they have:
MPC_062321-2L-118
July 21, 2022 update: We have postponed the date for Online Services retirement. Read more.
Last week we announced that we had not yet been able to move all user data to ConnectCenterTM, our new eTool for real-time transactions and professional claim submission. We’re pleased to announce that ConnectCenter is now fully available to existing Online Services users. You can use ConnectCenter to:
You can access ConnectCenter when you're logged into Provider Central (no separate username or password is required). Our new ConnectCenter page includes extensive resources to help you, including:
Exciting new features
ConnectCenter has a fresh modern interface and offers new tools and reports to streamline your work.
For professional 1500 claim submission, ConnectCenter will allow you to:
Important dates
ConnectCenter is replacing Online Services, which will be phased out between now and August 12, 2022. All existing Online Services users will need to switch to ConnectCenter by:
New Provider Central users will only be registered for ConnectCenter. This means they will need to use ConnectCenter for all of its features, including claim submission.
Action items
MPC_062321-2L-13
This article is for all medical providers, office staff, and billing agencies who submitted professional (1500) claims for our members using Direct Data Entry through Online Services.
As we have been transitioning our claims submission capabilities from Online Services to ConnectCenter, you may be wondering how to access claims originally submitted using Online Services.
To | Log onto ConnectCenter and go to |
---|---|
Check the status of the claim | Claims>Claim Status to inquire about any claim submitted to Blue Cross Blue Shield of Massachusetts, including claims submitted through Online Services. |
Obtain appeals documentation
or Confirm that a claim that you can’t find using Claim Status was submitted to Blue Cross |
Claims>Customer Portal (which was called Reporting & Analytics in Online Services). To log onto this area, you will need a user number and password:
|
Correct a claim | Use ConnectCenter to re-enter the claim with any needed corrections. For future claims for this member, you’ll be able to save time by copying the accepted claim. |
* For general ConnectCenter support, please call Change Healthcare at 1-800-527-8133.
To help you with this transition:
MPC_062321-2L-59
The Consolidated Appropriations Act (CAA) requires provider directory information to be verified every 90 days. Providers and health insurers have roles in fulfilling this requirement to maintain an accurate directory. Therefore, it’s important you keep your directory information accurate and up to date.
Starting January 1, 2022, you must:
If you are a clinician—including behavioral health providers, we recommend using the Council for Affordable Quality Healthcare (CAQH) ProView®’ portal to quickly verify and update your practice location information with us every 90 days. CAQH Proview will send email verification and re-attestation reminders.
If you are a facility, group practice, or lab, we’ll reach out to you to review and validate your information quarterly. Updates will be reflected in our Find a Doctor & Estimate Cost provider directory.
Keep in mind, contractual changes may require you to submit more information. Please review the forms here.
Under CAA, we are required to remove provider practice locations from our directory whose location data we are unable to verify within 90 days. We recommend using CAQH Proview as you will receive quarterly reminders directly from them.
If you leave a Blue Cross network, please update your directory information immediately by submitting an update form.
If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.
MPC_052620-1Q-18
This article is for dentists and oral surgeons caring for our members
Dental Blue is working hard to support you and your practice during this challenging time. We wanted to make sure you know about all of the efforts we launched during 2020.
Earlier this month, we announced that we would provide Massachusetts-participating Dental Blue dentists an additional $10 or each Dental Blue patient (excluding Federal Employee Program and Medicare Advantage members) treated from June 1-August 31, 2020 to assist with the costs of personal protective equipment (PPE) as you return to practice.
Eligible providers do not need to take any action to receive this payment. We will review your claims history for dates of service from June 1-August 31. During the 4th quarter of 2020, we will send you $10 for each encounter with a Dental Blue patient in a single payment.
These payments will be outside of our normal claims process and will not count against members’ annual benefit maximum. To avoid delays in claim processing, please do not include CDT code D1999 or any other code for PPE when submitting claims.
In June, we eased time limits for preventive dental CDT codes to help you continue to serve patients who may have missed preventive dental services during the COVID-19 stay-at-home advisory. The changes to these services took effect on June 1, 2020 and will remain in place for most dental plans even after the state of emergency ends .
Since the start of the public health emergency, we have covered consultations by telephone or video (“virtual consultations”) between dental providers and their patients for all members who already have coverage for problem-focused exams (D0140). There is no cost share (deductible, copayment, or co-insurance) for these services. Note that the cost share is not waived for members of the Federal Employee Program.
In June, we suggested using CDT D1354 to bill for the application of a medicament to treat patients for advanced caries on a tooth where you may be otherwise unable to perform definitive care. For example, it could be used when you want to avoid treatment with a handpiece to minimize aerosol or for treatment plans that minimize patient appointment duration. Although this limited treatment doesn’t substitute for definitive care, it could provide your patient with interim care while helping to keep you, your office staff, and your patients safe.
CDT code | Narrative |
---|---|
D0140 | Limited oral evaluation—problem-focused. This code is suggested for reporting telephonic or virtual visits |
D1354 | Interim caries-arresting medicament application per tooth |
Because we understand that the dental community in Massachusetts has been particularly impacted by the COVID-19 pandemic, Blue Cross has committed to donate to the Massachusetts Dental Society Foundation’s COVID-19 Recovery Fund. This donation is designed to assist financially struggling dental practices in the Commonwealth and will help offset the additional costs for PPE required to keep their patients – our members – safe.
MPC_030620-1N-116
We’re happy to let you know that we have updated the following resources on our website:
Document | Where to find on Provider Central (login required) |
---|---|
Dental Fee Schedules | Go to Office Resources>Billing & Reimbursement>Fee Schedules |
2020 Dental Blue Book CDT Dental Procedure Guidelines and Submission Requirements Pediatric Essential Health Benefits Dental Procedure Guidelines and Submission Requirements |
Go to Office Resources>Policies & Guidelines>Provider Manuals |
MPC_012219-1M-8
This article is for dentists and oral surgeons caring for our members
The following 2021 resources have been updated on our website:
We’ve updated the following 2021 information on our website:
Document |
Where to find on Provider Central (log on required) |
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Go to Office Resources>Billing & Reimbursement> Fee schedules |
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Go to Office Resources>Policies & Guidelines> Provider Manuals |
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MPC_010821-1K-3-ART
This article is for dentists and oral surgeons caring for our members
The following resources have been updated on our website with new information for 2022:
To download your fee schedule, log in and go to Office Resources>Billing & Reimbursement>Fee schedules.
MPC_020821-1K-9
This article is for dentists and oral surgeons caring for our members
The following resources have been updated on our website with new information for 2023:
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This article is for dentists and oral surgeons caring for our members
How to get started
All dental providers caring for Blue Cross of Massachusetts members – including those who participate in our National Dental Network – are eligible to use Dental Connect for Providers.
Our dental network managers have spent the summer talking to providers about the improvements we've made to Dental Connect for Providers, our online portal for eligibility, benefit, and claims information. Providers have been very happy with what they’ve seen. According to one office manager: “Being able to check full eligibility with insurance breakdown will be a life changer.”
With the upgraded version of Dental Connect, all dental providers – including those who participate in our National Dental Network – can check benefits and eligibility at their convenience, any time of the day or night. Some of the exciting new features include:
Office staff have been happy with the real-time demos that our Dental Network Management team delivered over Zoom. According to one: “Thank you for sharing the new technology. It makes it tangible and assists in setting up and will make numerous things easier.” Others raved that their Dental Network Manager gave great explanations of the new features!
To set up a time for your own personalized demonstration, please contact us by email at DentalNetworkRequest@bcbsma.com or call 1-800-882-1178, select option 4 followed by the option for your region:
Out-of-state providers should call your local Blue Cross plan.
MPC_061820-1U-15-ART
July 21, 2022 update: We have postponed the date for Online Services retirement. Read more.
This article is for all medical providers, office staff, and billing agencies who:
We’ve begun our transition to ConnectCenter, and urge you to learn more by attending one of our training webinars. Click here to register today!
Providers who currently use Online Services to submit 1500 claims using Direct Data Entry will need to begin using ConnectCenter by July 22. But it makes sense to begin using ConnectCenter as soon as possible! That’s because:
Our ConnectCenter eTools page offers many resources to help you get started today.
Please note: The Remits (electronic remittances) functionality in ConnectCenter is not available for Blue Cross of Massachusetts providers. Please continue to use Payspan for online Provider Payment and Provider Detail Advisories.
MPC_062321-2L-38
This article is for dentists and oral surgeons caring for our members
To ensure that we process your electronic submissions correctly, please make sure that you are using the most up-to-date version of your practice management software. In addition, we’d like to remind you about the coordination of benefit requirements for electronic claims submissions.
As you do for all claims, before submitting claims electronically you must determine the primary payer and submit the claim to that payer first. When Blue Cross Blue Shield of Massachusetts is the secondary payer, you must report:
You can learn more on our dedicated coordination of benefits page, including a member fact sheet and information about:
MPC_010821-5-ART
It’s here! Beginning December 1, 2019, you can electronically sign new contracts. Just click and sign, and your agreement is returned to us. Your electronic signature has the same legal effect as a handwritten signature.
How will it work?
When you complete an application or an update form, we’ll ask for the email address of the person who needs to sign the contract or Attachment A. The cover letter we send you will include detailed instructions on how to sign and return an agreement.
Our emails will be sent from Adobe Sign (echosign@echosign). When you sign a contract electronically, you'll receive a copy of the countersigned agreement. If you don’t receive an expected contract, please check your spam folders to make sure that our secure message wasn’t placed there.
It is our goal to provide a seamless transaction for your practice and make contracting more efficient.
Questions?
Please contact Network Management Services at 1-800-316-BLUE (2583).
MPC_120117-2V-4-ART (10/19)
This article is for all providers except dentists caring for our members
The Network Management and Credentialing Services phone line is now available, but email is still the best way to reach us. Please email ProviderApplicationStatus@bcbsma.com with your inquiries regarding credentialing and provider enrollment. If you need to call us, you can reach us at 1-800-316-BLUE (2583). Please wait 60 days from the date you request that we verify your credentials before contacting us to check your contracting status.
MPC_040121-1C-6
This article is for all medical providers
Effective immediately, our Network Management and Credentialing Services phone line is unavailable until further notice. This is expected to be a temporary closure, and we don’t have a re-opening date at this time.
If you have questions about credentialing or enrollment, please send an email to providerapplicationstatus@bcbsma.com. You can expect a response within a few business days, depending on inquiry volume. Please don’t call 1-800-316-BLUE (2583).
Please allow 60 days for new provider credentialing to be completed before sending an inquiry.
We will notify you when the phone line is back up and running.
MPC_040121-1C-3
This article is intended for behavioral health professionals, certified nurse midwives, nurse practitioners, physician assistants, physicians, and psychiatrists
It’s here! Providers can now electronically sign their provider contracts when new providers join your group or the practitioner makes a change. Just click and electronically sign, and your agreement is returned to us. Your electronic signature has the same legal effect as a handwritten signature.
When you complete an application or an update form, we’ll ask for the email address of the person who needs to sign the provider contract or Attachment A. The cover letter we send you will include detailed instructions on how to electronically sign and return the contract.
Our emails will be sent to you from Adobe Sign (echosign@echosign), an industry leader. When you sign a contract electronically, you'll receive a copy of the countersigned agreement. If you don’t receive an expected contract, please check your spam folders to make sure that our secure message wasn’t placed there.
It is our goal to provide a seamless transaction for your practice and make contracting more efficient.
Please contact Network Management and Credentialing Services at 1-800-316-BLUE (2583).
MPC_120117-2V-5
This article is for all prescribers caring for our members
Please be advised that our Pharmacy Operations department (1-800-366-7778) will be closing early at 3 p.m., ET on the below dates. If you call after 3 p.m., you will hear an automated message informing you that you are being transferred to CVS Caremark (our pharmacy benefit manager), which will be open for their regular business hours. Or, you can use your practice’s electronic prior authorization (EPA) tools.
Additionally, we will be closed for the entire day on the following dates. If you call on these days, you will be transferred to CVS Caremark, who will also be closed, but will intermittently check their voicemail and return calls. Alternatively, you can use your EPA tools.
Happy holidays, and as always, thank you for the care you provide to our members.
MPC_111523-1U-1-ART
This article is for all providers caring for our members
As you know, getting vaccinated against COVID-19 is one important step we can take to keep each other healthy, support our health care workers, and get Massachusetts businesses back on their feet. But public health experts have warned that hesitancy to get the COVID-19 vaccine may become a primary risk factor for further spread of COVID-19 and subsequent COVID-related deaths in the next year.
That’s why Blue Cross has been producing fact-based information about the safety and efficacy of FDA-authorized COVID-19 vaccines to share with our members and the general public. You can share these articles, videos, and websites with your patients who may be unsure or skeptical about the vaccine.
As a public service, we made a video and offered it free of charge on our Blue Cross YouTube channel for republication for any media, governmental, educational, or public health messaging effort. In the 2-minute video, Dr. Katherine Dallow, vice president of clinical programs and strategy at Blue Cross, shares her perspective as a physician on the promise of the new vaccines.
Our health news site, Coverage, also features in-depth articles on both the Moderna and Pfizer vaccines. Readers can also click on 45-second videos that highlight in plain language the most important facts, like how the vaccines work, and information on how safe and effective they are.
You may also direct your patients who are our members to the Coronavirus Resource Center where they can find frequently asked questions and answers, as well as current information on vaccines, finding care, and testing.
MPC_030624-1N-165-ART
This article is for dentists and oral surgeons caring for our members
We've significantly improved our Dental Connect for Providers, our online portal for eligibility, benefit, and claims information. With this upgrade, Dental Connect will give you faster answers for questions about members’ specific benefits.
All dental providers – including those who participate in our National Dental Network – can now get the information they need. Check benefits and eligibility at your convenience, any time of the day or night.
The enhanced version of Dental Connect for providers offers these exciting new features:
Click here for a quick demo of these new features that will enhance your office’s efficiency and help you spend time doing what you do best – caring for your patients, our members!
For a more detailed demo and help getting started, please contact us by email at DentalNetworkRequest@bcbsma.com or call 1-800-882-1178, select option 4 followed by the option for your region:
South Shore / Cape Cod Region select 1.
North Shore / New Hampshire select 2
Boston / Metro West /Dental Schools select 3
Western MA use email above.
Out-of-state providers should call their local Blue Cross plan.
MPC_061820-1U-4
The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used sets of heath care performance measures in the United States. HEDIS is one of the ways we measure the quality of care you provide to our members and is a very important activity for all NCQA-accredited health plans.
As required by the National Committee for Quality Assurance (NCQA), we will start to collect medical record information for the 2020 HEDIS audit (claims measurement year 2019) in February.
Your help in promptly submitting your medical records for all BCBSMA requests is important and part of your contract. If you use a vendor for your medical records, be sure they know that they cannot bill us for the records.
We know that you may sometimes receive record requests from different parts of our organization. We try to streamline these requests, but it is not always possible due to different reporting requirements. Your provider agreement requires you to respond to all medical record requests you receive from us. These support our medical management, quality management, compliance, and other programs.
We recommend using remote access or onsite reviews to ease your office’s administrative burden. To set up onsite reviews or remote access, please contact Patty Donoghue at the number below.
Request type | Mailed to your office | Submission options |
---|---|---|
HEDIS | Starting February 2020 |
Please contact us to discuss the best options for your group. |
Medicare risk adjustment record requests | Spring | |
Commercial risk adjustment record requests | Fall | |
Provider audits | Ongoing |
If you have any questions about HEDIS, or to set up remote access or onsite review, please Patty Donoghue at 617-246-8838 or 1-888-994-3347. Thank you in advance for responding promptly to this request.
MPC_090919-2P-1
HEDIS medical record collection will end on Friday, April 23. Be sure to submit all requested medical records to Blue Cross Blue Shield of Massachusetts, as required by the National Committee for Quality Assurance (NCQA) and your provider Agreement.
HEDIS is one of the ways we measure the quality of care you provide to our members and is a very important activity for all NCQA-accredited health plans.
Submission options
If you have not submitted your records, please do so using one of the following options:
As required by HIPAA regulations, please submit only the minimum necessary to satisfy the requested information.
If you use a vendor for your medical records, be sure they know that they cannot bill us for these records.
If you have any questions about HEDIS, please call 1-888-99-HEDIS (43347). To set up remote access, please contact Patty Donoghue at 1-617-246-8838. Thank you for responding promptly to this request.
MPC_092420-1P-4
HEDIS medical record collection will end Friday, April 29. Be sure to submit all requested medical records to Blue Cross Blue Shield of Massachusetts, as required by the National Committee for Quality Assurance (NCQA) and your provider Agreement.
HEDIS is one of the ways we measure the quality of care you provide to our members and is a very important activity for all NCQA-accredited health plans.
If you have not submitted your records, please do so using one of the following options:
Per HIPAA regulations, please submit only the minimum necessary to satisfy the requested information.
If you use a vendor for your medical records, be sure they know that they cannot bill us for these records.
If you have any questions about HEDIS, please call 1-888-99-HEDIS (43347). To set up remote access, please contact Ankita Desai at 1-617-246-6577. Thank you for responding promptly to this request.
MPC_082321-2X-4-ART
This article is for all providers except mental health providers, dermatologists, and dentists
This is a reminder that we will start collecting medical record information for the 2023 Healthcare Effectiveness Data and Information Set (HEDIS) review (claims measurement year 2022) in February, as required by the National Committee for Quality Assurance (NCQA). Our members, your patients, are randomly selected for this review.
HEDIS is one of the ways we measure the quality of care you provide to our members and is a very important activity for all NCQA-accredited health plans.
Your help in promptly submitting medical records for all Blue Cross Blue Shield of Massachusetts HEDIS requests is required as part of your Blue Cross agreement. Per HIPAA regulations, please submit only the minimum necessary information to satisfy the request.
To minimize disruption to your office, we strongly recommend providing us with remote access.
If you use a vendor for your medical records, be sure they know that they cannot bill us for these records.
If you have any questions about HEDIS, please call 1-888-99-HEDIS (43347). To set up remote access, please contact:
Thank you in advance for responding promptly to this request.
MPC_101122-3X-3
When provider directories have inaccurate information, it creates barriers for patients who need care as they are forced to call several provider offices before they can find one that meets their needs and is accepting patients. Therefore, it’s important you keep your directory information accurate and up to date.
The law requires us to keep directory information on our website current, and we can’t do it without your help. This requirement applies to all providers in our network. If you do not keep your data current and attest to its accuracy regularly, you could be removed from our directory.
To validate the information on our website:
Be sure to validate: | |
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|
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Note: A new practice display limitation policy will take effect on November 1, 2021. This policy will limit the number of locations that we’ll display for an individual provider in our directory to five practice locations. Read more here.
Update your information using Council for Affordable Quality Healthcare (CAQH) ProView®'.
It is important that you review your CAQH Proview data and attest to its accuracy every 120 days. If your information is not attested to regularly, we will suppress you from our directory.
We use CAQH ProView for credentialing and recredentialing and we now use it to ensure accuracy in our provider directories with DirectAssure. DirectAssure works within ProView and allows you to update professional and practice information and share it with multiple health plans. This streamlines the communication process for you and keeps your credentialing information current to avoid any delays in the recredentialing process, which occurs every 2 years.
Keep in mind, contractual changes may require you to submit more information.
We may send you multiple requests to validate your information and request feedback. This outreach may include letters, phone calls, and emails from Blue Cross. Please note that we also use Alchemer to conduct our emails and surveys. Be sure to look out for these requests and respond to them promptly.
If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.
MPC_052620-1Q-17
This article is for providers and discharge planners who refer our members for home health care services in Central Massachusetts.
HealthAlliance Home Health & Hospice, Inc. is leaving the Blue Cross Blue Shield network as of August 31, 2022. Effective September 1, you’ll need to refer new patients to a participating in-network provider for home health and hospice services.
Below is a list of in-network health care and hospice providers serving central Massachusetts. Use our Find a Doctor directory to find additional home health care and hospice providers serving your patient’s area. Service areas may vary, so please check with these providers to ensure they offer services in the city or town where your patient lives.
Provider organization | NPI | Phone number |
---|---|---|
ACE Medical Services - Worcester | 1528180759 | 1-508-792-3800 |
Acclaim Home Health, Inc. - Worcester | 1801843495 | 1-508-459-6937 |
Aveanna Healthcare - Worcester | 1588662449 | 1-508-421-6800 |
Bayada Home Healthcare - Marlborough | 1043501612 | 1-800-305-3000 |
Better Care Home Health, Inc. - Sterling | 455165191 | 1-978-537-2273 |
Elara Caring - Worcester | 1417934654 | 1-508-754-5513 |
Care Central VNA and Hospice, Inc. - Gardner | 1477526705 | 1-978-632-1230 |
Jewish Healthcare Center - Worcester | 1831337211 | 1-508-713-0538 |
Medical Resources Home Health Corp - Worcester | 1417934654 | 1-508-754-5513 |
Nashoba Nursing Service & Hospice - Shirley | 1437102431 | 1-978-425-6675 |
Oriol Home Health - Holden | 1174038871 | 1-508-829-1140 |
Overlook Visiting Nurse Association - Charlton | 1033176144 | 1-800-990-7643 |
VNA Care Network - Worcester | 1922002286 | 1-800-728-1862 |
Provider organization | NPI | Phone number |
---|---|---|
Beacon Hospice - Leominster | 1386839520 | 1-978-466-7890 |
Care Central VNA and Hospice, Inc. - Gardner | 1932172160 | 1-978-632-1230 |
Jewish Healthcare Center - Worcester | 1447364690 | 1-508-713-0512 |
Notre Dame Hospice - Worcester | 1689703068 | 1-508-852-5800 |
Overlook Visiting Nurse Association Hospice - Charlton | 1033176144 | 1-800-990-7643 |
VNA Care Hospice, Inc - Worcester | 1821092180 | 1-800-521-5539 |
Nashoba Nursing Service and Hospice - Shirley | 1851429740 | 1-800-698-3307 |
Patients currently receiving services from HealthAlliance may be eligible to continue in-network care with HealthAlliance.
If a patient | They may be covered at the in-network level |
---|---|
Has a serious and complex condition, is receiving inpatient care, or is scheduled for a non-elective surgery | Until November 30, 2022, or when active treatment is no longer required, whichever is earlier |
Is pregnant |
Until November 30, 2022, or through their first post-partum visit, whichever is longer |
Has a terminal illness | Until their death. |
MPC_062422-2X-5-ART
Provider directories are important to helping patients find the care they need. Therefore, it’s important you keep your directory information accurate and up to date.
The Consolidated Appropriations Act (CAA) requires provider directory information to be verified every 90 days. Providers and health insurers have roles in fulfilling this requirement to maintain an accurate directory. Therefore, it’s important you keep your directory information accurate and up to date.
You are required to:
If you are a clinician—including behavioral health providers, we recommend using Council for Affordable Quality Healthcare (CAQH) ProView®’ portal to quickly verify and update your practice location information with us every 90 days. CAQH Proview will send email verification and re-attestation reminders.
If you are a facility, group practice, or lab, we’ll reach out to you to review and validate your information quarterly. Updates will be reflected in our Find a Doctor & Estimate Costs provider directory.
Keep in mind, contractual changes may require you to submit more information. Please review the forms here.
Under CAA, we are required to remove provider practice locations from our directory whose location data we are unable to verify within 90 days. We recommend using CAQH Proview as you will receive quarterly reminders directly from them.
If you leave a Blue Cross network, please update your directory information immediately by submitting an update form.
If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.
MPC_052620-1Q-29
This article is for all providers caring for our members
As a reminder, all providers will be required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax starting June 1, 2023 for our commercial (HMO, PPO) and Federal Employee Program (FEP) members. Authorization Manager is the most efficient method to submit requests, and it’s available 24/7 at no additional cost via single sign-on through Provider Central!
Both medical and mental health providers will need to use Authorization Manager starting June 1. To help prepare you, here are some general tips:
Why wait? Start using Authorization Manager today to review authorization requirements, request authorizations, check existing case status, and view or print the decision letter. This tool also allows you to:
To read our News Alert announcing this upcoming mandate, log on to bluecrossma.com/provider and click News. Scroll down to the February 1 communication: “Submit referrals, authorization requests, and inquiries electronically starting June 1.”
Read our News Alert announcing this upcoming mandate: “Submit referrals, authorization requests, and inquiries electronically starting June 1.”
We’re here to help. Please send an email to us at hmmauthorizationmanager@bcbsma.com with any questions you may have about Authorization Manager.
MPC_012618-1L-96-ART
This article is for providers who use Authorization Manager to submit requests for musculoskeletal services
Thank you for using Authorization Manager to submit your requests for musculoskeletal services!
After reviewing your submissions over time, we’ve compiled some of the most common errors below, with tips on how to avoid them. We hope this information helps to improve the accuracy of your requests, minimizes pended cases that require manual review, and allows for an overall more efficient process for you.
Common errors | How to avoid making mistakes |
---|---|
Selecting the patient’s age |
If the patient is 18 years or older, choose the top option:
If the patient is under 18 years old, choose the bottom option:
Note: Some procedures, such as knee replacements, are not appropriate for patients under 18. If you select the incorrect age, your request may pend for manual review. |
Selecting number of symptoms |
If the patient has two or more symptoms based on their clinical documentation, then select at least two symptoms from the list when prompted. If you don’t select at least two symptoms when the patient does have them, your request will pend for manual review. |
Selecting unilateral versus bilateral knee replacements |
If the patient will have one knee replaced, then select “Yes” when asked if a unilateral knee replacement is planned. Choosing “No” implies that the surgical plan is to perform bilateral knee replacements (both knees replaced during the same surgery). |
Selecting a Medicare subset for Medicare Advantage |
For Medicare Advantage members, you must select a Medicare subset when applicable, followed by a Jurisdiction. For Massachusetts, the appropriate Jurisdiction is National Government Services (NGS). |
MPC_030822-2N-8-ART
This article is for all providers caring for our members
If you have patients with out-of-state Blue plans (known as BlueCard members), you don’t have to call that other plan to request authorization. Instead, you can use the single sign-on Electronic Provider Access (EPA) tool directly from Provider Central.
The EPA tool allows for an easier and more efficient way to submit requests for BlueCard members. By entering the three-character prefix from the member’s ID card, you will be automatically routed to their Blue plan’s EPA landing page. This page will connect you to the plan’s available electronic pre-service review options.
To access the EPA tool, log in to Provider Central, click on eTools>Pre-service review for BlueCard members, and then click Go Now.
MPC_080824-4L-1
This article is for dentists and oral surgeons caring for our members
Our Dental Network Management team enjoyed visiting with all the dentists, clinicians, and office staff who attended the Yankee Dental conference in January. Many of the attendees appreciated the Fact Sheet that we handed out at the event. If you missed it, you can download the digital version and post it prominently in your office so you’ll always know how to find the answers to your questions about Dental Blue programs, benefits, and provider technologies.
If you weren’t able to attend – or if you have more questions or concerns – your Dental Network Manager is available to connect with you in your office or by Zoom. Please feel free to call the appropriate representative by calling: 1-800-882-1178 option 4 and then selecting the appropriate region:
Four lucky attendees who stopped by our booth won an iPad in our raffle. Congratulations to:
MPC_010323-1P-2
We are working to fix technical issues that may impact your ability to submit requests for authorizations via Authorization Manager and Online Services. As a result, we have temporarily disabled the ability to submit authorization requests via Authorization Manager. For authorization requests, please follow these instructions:
Thank you for your patience. We will notify you as soon as these issues are resolved.
MPC_012618-1L-51
This article is for all medical providers, office staff, and billing agencies who use Online Services
To allow more time for you to set up patient data and start submitting claims on ConnectCenter, we will be removing the claim submission feature in Online Services on a rolling basis.
If you | Then |
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Have already been using ConnectCenter for claim submission | Claim submission will be unavailable in Online Services after Sunday, July 31. |
Have not yet entered a claim in ConnectCenter |
We will email you advance notice of the date when claim submission in Online Services will be unavailable for you.
These emails may be sent as early as next week. |
The remaining Online Services functions—benefit and eligibility inquiries, claim status, and referrals—will be discontinued after Friday, September 30.
If you use the Patient List feature in Online Services, it’s important that you:
Taking these steps will populate your Eligibility History, making it easier for you to submit claims for these patients in ConnectCenter.
Below is a sample Online Services Patient List. You can copy patient details by first clicking the Edit link in the Actions column.
Access your search history in ConnectCenter by going to Verification>Search Eligibility History. To see every eligibility transaction, simply click the Search button.
MPC_062321-2L-90
This article is for all medical providers, office staff, and billing services that use Online Services
We had announced that ConnectCenterTM would be available for all users on May 2. However, we have not yet moved all user data. Therefore some users may experience an error when attempting to use the tool.
As we work to address this issue, please continue to use Online Services for real-time transactions and 1500 claim submissions. We will notify you when these updates are complete.
If you registered for Provider Central after April 25, please use ConnectCenter. Online Services is not available to new users.
We thank you for your patience as we work to launch this improved tool for you.
MPC_062321-2L-40
This article is for all providers except dental.
Inovalon is the vendor that the Blue Cross Blue Shield Association uses to gather medical records for out-of-area Blue Cross Blue Shield plan members. Your submission of records supports Healthcare Effectiveness Data and Information (HEDIS), risk adjustment, and government-required programs related to the Affordable Care Act.
For example, if a Blue Cross Blue Shield of Florida member visits a contracted Blue Cross Blue Shield of Massachusetts doctor, Inovalon may ask for records for that Florida patient.
Blue Cross Blue Shield plans will follow the timeline below for quality data collection activities in 2020:
Start date | End date | |
---|---|---|
HEDIS | January 2020 | May 2020 |
MRA | May 2020 | December 2020 |
HRADV | June 2020 | December 2020 |
CRA / RADV | January 2020 | December 2020 |
When Inovalon requests copies of medical records for a Blue Cross Blue Shield member, please respond directly them. Do not send the records to us.
Fax | 1-877-221-0604 |
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FedEx | Call 1-800-463-3339 for instructions |
EMRService@inovalon.com (send secure) |
If you have questions about delivery options or methods, please call
1-844-682-9764.
MPC_051718-2J-3
This article is for all providers caring for our members
We’re excited to announce that we have a new Provider Central mental health page, a dedicated compilation of mental health-related resources and guidelines in one place.
The page includes a variety of topics categorized into easy-to-navigate sections, making it easier than ever to access the information you need. It contains:
Please visit and share this helpful resource with your colleagues and office staff.
MPC_080922-2N-3
This article is for all medical providers caring for our members
We’re excited to introduce Team Blue Care, our new care management mobile app that launched on December 15, 2022. Select commercial members (HMO, PPO, Indemnity) are eligible to download this app at no additional cost and use it to receive digital care management. Federal Employee Program (FEP) and Medicare Advantage members are not eligible for the program at this time.
By engaging with our Team Blue Care app, your patient can:
You don’t need to take any action for your patient to participate. Our care management team will reach out to eligible members to inform them of this new, helpful resource.
If you have any questions, please call our Health and Medical Management Team Blue at 1-800-392-0098. As always, thank you for the care you provide to our members.
MPC_020322-1I
This article is for the health care physicians, clinicians, and office staff caring for our Medicare Advantage members
We’re pleased to introduce the 2024 Medicare Advantage 5-Star Provider Playbook to support you and your office staff in caring for Medicare Advantage patients.
Download your 5-Star Provider Playbook
This resource guide is designed to provide you with actionable, evidence-based information, tips, and best practices to help you coordinate your patient’s care and improve health outcomes. The Playbook:
We hope this Playbook serves as a resource to support your quality and patient experience improvement efforts. Working together, we can achieve a CMS 5-Star quality rating to give our members—and your patients—the value they deserve from their health plan.
When Star Ratings improve for our Medicare HMO and PPO plans, our members benefit by:
And when you participate in a health plan with a high star rating, it shows that you, too, have achieved high standards.
To learn more, visit our dedicated CMS Stars page or if you have questions about Blue Cross Blue Shield of Massachusetts and the Star Rating Program, please contact:
We value your partnership and look forward to continuing to work with you to improve the quality of our Medicare Advantage members’ health care and their overall experiences with the health care system.
MPC_060424-1P-1-ART
This article is for all providers caring for our members
When looking for care, your provider directory information lets patients know if you’re in network, where to find you, the services you offer, and more. Make it easy for patients to find you by keeping your directory information up to date. We recommend assigning someone in your office to manage all provider directory activities—including attesting in CAQH Provider Data Portal or responding to Blue Cross surveys every 90 days.
Regulations require us to verify provider directory information every 90 days1. When you keep your directory information up to date, verifying only takes minutes. Save time by updating your information as it changes, including if you join or leave the Blue Cross network.
If you are a clinician—including behavioral health providers, review your information in the CAQH Provider Data Portal. CAQH also sends email verification and re-attestation reminders.
If you are a dentist, facility, group practice, or lab, we’ll ask you to complete a survey each quarter to validate your information. We’ll send you an email or letter on how to access the survey when it’s your time for review.
Dentists: Our dental survey campaign launched in June and is open until July 16th. Click “Dental Providers” below to review. Note: Clicking the link below will re-direct you to our directory survey on Alchemer. Please enter your NPI as the password.
For other types of changes, including changes to your contract or leaving the Blue Cross network, please review the forms here. If you are a dental provider that needs to report this information, you are advised to contact your dental network manager.
If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.
Visit Find a Doctor & Estimate Cost to see your current listing in our provider directory.
1. The Consolidated Appropriations Act (CAA) requires us to remove provider practice locations from our directory whose location data we are unable to verify within 90 days.
MPC_052620-1Q-61
This article is for dentists and oral surgeons caring for our members
Provider directories are important to helping patients find the care they need. Therefore, it’s important you keep your directory information accurate and up to date.
The Consolidated Appropriations Act (CAA) requires provider directory information to be verified every 90 days. Providers and health insurers have roles in fulfilling this requirement to maintain an accurate directory.
You are required to:
We’ll continue to contact you by email or phone to validate your data in our provider directories. The validation process involves a short survey to check that we have your most current address, phone numbers, and specialty. This process ensures that our members are able to contact you.
Keep in mind, contractual changes may require you to submit more information. If you need to update this information or if you leave the network, please contact our Dental Network Management team at: dentalnetworkrequests@bcbsma.com.
Under CAA, we are required to remove provider practice locations from our directory whose location data we are unable to verify within 90 days.
If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.
MPC_030222-3R-9
This article is for dentists caring for our members
Starting today, we will only provide information about a limited number of CDT codes over the phone.
You can access the information you need about our procedure guidelines and submission requirements for CDT codes online. Download our 2022 CDT Procedure Guidelines and Submission Requirements to have this information ready any time you need.
You can also find our coding guidelines – along with our Dental Blue Book and Pediatric Essential Health
Benefits Guidelines and Submission Requirements – by going to: Office
Resources > Billing Guidelines and Resources > CDT
Guidelines. Once you open the PDF, you can use “CTRL F” to search and find a specific code in the PDF.
MPC_030222-3R-7
This article is for dentists and oral surgeons caring for our members
Provider directories help our members find the care they need. Therefore, it’s important you keep your directory information accurate and up to date.
The Consolidated Appropriations Act (CAA) requires provider directory information to be verified every 90 days. Providers and health insurers have roles in fulfilling this requirement to maintain an accurate directory.
You are required to:
Beginning next week, we'll be contacting you by email or phone to validate your data in our provider directories. The validation process involves reviewing your information in our system to check whether we have your most current address, phone numbers, and specialty. This process ensures that our members are able to contact you.
Keep in mind, contractual changes may require you to submit more information. If you need to update this information or if you leave the network, please contact our Dental Network Management team at: dentalnetworkrequest@bcbsma.com.
Under CAA, we are required to remove from our directory provider practice locations whose data we are unable to verify within 90 days.
If you have questions, please email us at ProviderDirectoryInfo@bcbsma.com.
MPC_030222-3R-2-ART
Provider directories are important to helping patients find the care they need. Therefore, it’s important you keep your directory information accurate and up to date.
The Consolidated Appropriations Act (CAA) requires provider directory information to be verified every 90 days. Providers and health insurers have roles in fulfilling this requirement to maintain an accurate directory.
You are required to:
Keep in mind, contractual changes may require you to submit more information. Please review the forms here.
Under CAA, we are required to remove provider practice locations from our directory whose location data we are unable to verify within 90 days. We recommend using CAQH ProView as you will receive quarterly reminders directly from them.
If you leave a Blue Cross network, please update your directory information immediately by submitting an update form.
If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.
MPC_052620-1Q-27
This article is for all providers caring for our members
When looking for care, your provider directory information lets patients know if you’re in network, where to find you, the services you offer, and more. Make it easy for patients to find you by keeping your directory information up to date.
Regulations require us to verify provider directory information every 90 days1. When you keep your directory information up to date, verifying only takes minutes. Save time by updating your information as it changes, including if you join or leave the Blue Cross network.
If you are a clinician—including behavioral health providers, review your information in Council for Affordable Quality Healthcare (CAQH) Provider Data Portal—formerly known as ProView. CAQH Provider Data Portal also sends email verification and re-attestation reminders.
If you are a dentist, facility, group practice, or lab, we’ll ask you to complete a survey each quarter to validate your information. We’ll send you an email or letter on how to access the survey when it’s your time for review.
For other types of changes, including changes to your contract or leaving the Blue Cross network, please review the forms here. If you are a dental provider that needs to report this information, you are advised to contact your dental network manager.
If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.
Visit Find a Doctor & Estimate Cost to see your current listing in our provider directory.
1. The Consolidated Appropriations Act (CAA) requires us to remove provider practice locations from our directory whose location data we are unable to verify within 90 days.
MPC_052620-1Q-46
This article is for all medical providers caring for our members
Looking for tips and reminders on how to efficiently do business with us? Join us for a claims overview webinar designed for all medical providers and their office staff!
Date: Wednesday, October 9, 2024
Time: 1 p.m. – 2 p.m., ET
Our experts will cover these topics and more:
If you’re unable to attend, we’ll post a recording of the webinar onto Provider Central afterwards.
Please register for the webinar by Friday, September 27. You’ll need to enter your name and information about your practice or organization, such as NPI and specialty.
Additionally, you may submit questions (not about specific claims or members) through the registration survey. By receiving your questions in advance, we will be able to prepare comprehensive responses to best help you.
MPC_081624-1L-1-ART
This article is for all providers caring for our members
To help you get quick and convenient access to information about your patient’s eligibility, benefits, and claims, we offer a number of technology tools through our website. To see what we offer and how to use those tools, you can now access information about the tools without logging in on our eTools page.
You’ll find descriptions of our web-based technologies for:
We offer quick tips, tutorials, and other resources to help support you with these tools.
Then, when you’re ready to start using our eTools, you’ll still need to log in for full access.
Dentists:
All dental providers caring for Blue Cross of Massachusetts members – including those who participate in our National Dental Network – are eligible to use Dental Connect for Providers. Go to the Dental Connect page to find out how to register for Dental Connect. Dental Connect lets you check eligibility and benefits for all Dental Blue members 24/7 and provides details that previously were only available by calling our Dental Provider Service team.
MPC_061820-1U-13-ART
This article is for dentists and oral surgeons caring for our members
Join us for an upcoming webinar featuring Dental Connect.
Session 1: June 23, 2022 12:00 p.m. - 1:00 p.m. ET |
|
Session 2: July 12, 2022 12:30 p.m. - 1:30 p.m. ET |
We encourage you to attend if you want to increase the convenience of doing business with us using our online benefits and eligibility tool, Dental Connect. We'll provide assistance with registration for new users and offer a refresher on the benefits of the tool if you've already registered.
Dental Connect gives you 24/7 access to:
|
Benefit history - see the last time a procedure was performed. For example: check when a member had their last cleaning. |
|
Check benefits by service type or CDT procedure codes. |
|
View benefit frequency limitations such as how often a crown is covered under a member’s plan. |
|
Deductible remaining - view a member’s benefit dollars used to-date and deductible remaining, if applicable. |
Please make sure you're receiving our emails so you receive all of the registration information.
MPC_030222-3R-2
This article is for dentists and oral surgeons caring for our members and their office staff
Join us on December 6 for a webinar that will teach you how to register for and use Provider Central
Office staff who want to learn how to access your fee schedules, billing guidelines, News Alerts (contractual notices), payment policies, and CDT guidelines.
During the webinar, you will learn:
Reserve your spot by registering here.
This article is for dentists and oral surgeons caring for our members
Join us on February 21 at 1 p.m. for a Zoom webinar that will teach you how to:
Office staff who want to learn how to access your fee schedules, billing guidelines, News Alerts (contractual notices), payment policies, and CDT guidelines.
Reserve your spot by registering here.
MPC_010323-1P-6