Provider Central

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:

• We will send emails each month to “inactive” users notifying them that we will deactivate their account since they haven’t logged in.
• To avoid deactivation, all they need to do is log in within three (3) days of receiving our email.

What should Provider Central administrators do?

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:

• AIM will be Carelon Medical Benefits Management.
• Beacon Health Options will be Carelon Behavioral Health.

How we’ll work with Carelon Medical Benefit Management

As you know, many of our authorization programs are administered by AIM, an independent company.

• You can continue to request authorizations through the eTools link on Provider Central or by going directly to providerportal.com. The logo on ProviderPortal will be updated.
• The phone numbers will remain the same, but the recorded scripting will be replaced with the Carelon Medical Benefits Management name.
• Logos and references to AIM Specialty Health on authorization decision letters and other communications will be updated with the new Carelon name.

How we’ll work with Carelon Behavioral Health (formerly Beacon Health Options)

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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You told us you’d like more information available on our website without logging in. We’ve recently updated Provider Central to give you access to the following—whether you are logged in or not:

• Clinical Resources: Here, you’ll find:
• Clinical criteria we use to make medical necessity decisions for certain behavioral health and medical services.
• Information and resources about services that require prior authorization. We’ve also completely updated the behavioral health prior authorization page to make it easier to understand which behavioral health services require an authorization.
• Our InterQual Criteria & SmartSheets page, where you can find instructions on how to access the InterQual Level of Care Criteria web application.
• An outline of our total population health approach to health management, plus how we make the connection between oral and overall health. You’ll also find treatment resources you can use to support your patients’ care, including a recently added pain management section with an overview of our coverage and policies related to pain management and substance use disorders.
• Maintaining & Changing Status: Describes how medical and dental providers can notify us of any address, network, product, or contractual changes.
• Referrals: Gives information on how to enter and verify referrals and which services don’t require one.
• Reviews & Appeals: Provides contact information for administrative or claim appeals.

We hope these changes make it easier to find the information you need quickly and easily.

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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).

About ConnectCenter

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.

How to prepare

• Please notify anyone within your organization who uses Online Services and your billing agency.
• If you haven’t already, attend one of the many webinars being offered to support you in this transition.
• Start using Authorization Manager to enter authorization requests and check their status.

Resources

• ConnectCenter page. We offer a ConnectCenter Quick Start Guide, 1500 Claim Entry with ConnectCenter Quick Tip, and Checking Claim Status Quick Tip on this page along with many other resources to help you get started.
• Authorization Manager page. Scroll to our “Guides and video demonstrations” section to access the Authorization Manager User Guide, Specialist Referrals Quick Tip, and more.
• Referrals page.

Questions?

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:

• July 22 for claim submission
• August 12 for eligibility and claim status

About ConnectCenter

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.

Take action now

• Please notify anyone within your organization who uses Online Services and your billing agency.
• If you haven’t already, attend one of the many webinars being offered to support you in this transition.
• Start using Authorization Manager to enter authorization requests and check their status.

Resources

• ConnectCenter page. We offer a ConnectCenter Quick Start Guide, 1500 Claim Entry with ConnectCenter Quick Tip, and Checking Claim Status Quick Tip on this page along with many other resources to help you get started.
• Authorization Manager page. Scroll to our "Guides and video demonstrations" section to access the Authorization Manager User Guide, Specialist Referrals Quick Tip, and more.
• Referrals page.

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When members are looking for medical care, online provider directories are important tools for helping them find network providers. Patients and their caregivers rely on our directories for contact and other critical information when making health care decisions.

That’s why it’s important that our online resources are accurate. The law requires us to keep the information on our website current, and we can’t do it without your help. This requirement applies to all providers in our network.

What to do first
Verify that your information on our website is correct.

1. Go to Find a Doctor & Estimate Costs. You don't need to log in, just select one of the networks you participate in.
2. Check the record for all your site locations.*
   • Names
   • Addresses
   • Phone numbers
   • Specialties
   • Medical groups
   • Hospital affiliations
   • Gender
   • Board certification
   • Languages spoken
   • Whether you are accepting new patients
   • Whether you offer telemedicine

   *Only addresses where members can make appointments with clinicians should be in the directory.

3. If everything is accurate, you don’t need to do anything else.

When updates are needed
Since you can’t update the Find a Doctor & Estimate Costs site by yourself, use one of the forms listed below:

* Doctors: remember to go CAQH to update your recredentialing application there as well as on the form.

Don’t wait – keep your information current
Even if your information is up-to-date now, please be sure to submit changes as they arise throughout the year.

As always, thank you for the care you provide to your patients—our members.

Questions?
Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).

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Andrew Dreyfus, president & CEO, to step down
at end of 2022

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.

Payspan webinar shows you how to register and use the website

• Wednesday, May 19, 2021
  1:30 p.m. – 3:00 p.m.
  https://fuze.me/webinars/register/1158622


• Wednesday, June 16, 2021
  1:30 p.m. – 3:00 p.m.
  https://fuze.me/webinars/register/1158698


• Wednesday, July 21, 2021
  1:30 p.m. – 3:00 p.m.
  https://fuze.me/webinars/register/1158702

What you can do with Payspan

• Receive your payments by secure EFT
• Verify the weekly status of your checks
• Access claim and payment data 24/7
• View, print, and search Provider Payment Advisories (PPAs) and Provider Detail Advisories (PDAs)
• Obtain Account Receivable information

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.

Can’t join the webinar? How to learn more

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.

Attend a Payspan webinar to learn how to register and use the website

• Wednesday, Aug 18, 2021
  1:30 p.m. – 3:00 p.m.
  https://fuze.me/webinars/register/1159590


• Wednesday, Sep 15, 2021
  1:30 p.m. – 3:00 p.m.
  

  https://fuze.me/webinars/register/1159594

• Wednesday, Oct 20, 2021
  1:30 p.m. – 3:00 p.m.
  https://fuze.me/webinars/register/1159598

What you can do with Payspan

• Receive your payments by secure EFT
• Verify the weekly status of your checks
• Access claim and payment data 24/7
• View, print, and search Provider Payment Advisories (PPAs) and Provider Detail Advisories (PDAs)
• Obtain Account Receivable information

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.

Can’t join the webinar? How to learn more

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:

• Claims and claim status
• Real-time transactions, including eligibility and claim status

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. 

To request Applied Behavior Analysis (ABA) services via Authorization Manager

• For an initial assessment, use CPT code 97151. Do not submit any other codes on your ABA Service Request Form for this initial request.
• If you need to request additional treatment after the initial assessment, submit another request for 97151 in Authorization Manager. This time, include the treatment codes that you are requesting approval for on your ABA Service Request Form.

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.

Advantages of using Authorization Manager – start today!

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:

• Search member-specific authorization requirements by code or by provider number to look up multiple patients at the same time.
• Check the status of requests no matter how they were submitted.
• Upload additional clinical documentation to an existing case.
• Enter a transaction within minutes. By the time you call and talk to a service representative, you could have entered an authorization request!

Resources

• Applied Behavioral Analysis Service Request Form
• Authorization Manager User Guide
• Authorization Manager Provider Central page, which contains helpful tips, guides, and video demonstrations

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."

Questions?

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:

• What resources are available on our Provider Central website for billing agencies and providers who use billing agencies
• Where to find self-service resources to get the information you need
• How to sign-up for Provider Central, obtain claim status, and more!

If your organization uses a billing agency, please share our Brainshark with them.

Resources

• Brainshark: Information for billing agencies
• Info for billing agencies
• Quick Tip: Claim Status

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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:

• Follow our detailed guide for fertility services and ART.
• Watch this short video demonstration of how to enter a request for fertility services and ART authorizations.
• An EPM referral is only needed for members with managed care plans and requires an approved in vitro fertilization (IVF) authorization first.
  • Watch this short video demonstrating the step-by-step process of how to submit a request for EPM services.

Advantages of using Authorization Manager – start today!

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:

• Search member-specific authorization requirements by code.
• Check the status of requests regardless of how they were submitted.
• Upload additional clinical documentation to an existing case.
• Enter a transaction within minutes. By the time you call and talk to a service representative, you could have entered an authorization request!

Resources

• Fertility Services/ART Authorization Manager demo video
• Early pregnancy monitoring Authorization Manager demo video
• Authorization Manager User Guide
  
• Authorization Manager Provider Central page, which contains helpful tips, guides, and video demonstrations
• Assisted Reproductive Technology (ART) Service Form

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.”

Questions?

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:

• For all outpatient requests, click on “Request Medical PA” and enter your patient’s information. Then, select “Behavioral Health Service Request” or “Behavioral Health Inpatient” as the request type.
• Follow our detailed guides for either inpatient or outpatient mental health services.
• Psychological testing and neuropsychological testing each require their own separate authorization request.
• Requests for psychological testing may be automatically approved.
• For psychological testing, only 96130 and 96131 require authorization.
• For neuropsychological testing, only 96132 and 96133 require authorization.

Advantages of using Authorization Manager – start today!

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:

• Search member-specific authorization requirements by code.
• Check the status of requests regardless of how they were submitted.
• Upload additional clinical documentation to an existing case.
• Enter a transaction within minutes. By the time you call and talk to a service representative, you could have entered an authorization request!

Resources

• Authorization Manager User Guide
• Authorization Manager Provider Central page, which contains helpful tips, guides, and video demonstrations

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.”

Questions?

Please send an email to us at hmmauthorizationmanager@bcbsma.com with any questions you may have about Authorization Manager.

Attend a webinar to learn more

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.

Attend our webinar February 4, 2021 to learn more

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:

• Accessing Authorization Manager
• Entering authorization requests
• Searching for authorizations and referrals
• Using forms
• Viewing status of referrals and authorizations (including vendor authorizations)

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

More information

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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.

Making sure your Blue Cross provider numbers show in Authorization Manager

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. 

• To see which of your Blue Cross provider numbers are currently associated with your Provider Central username, log in and click My Organizations at the top right of homepage.
• To add a Blue Cross provider number to your Provider Central account, click Add an Organization on the My Organizations page and follow the prompts. You will need your organization’s Blue Cross provider number or NPI, and your tax identification number.
• When searching for an authorization in Authorization Manager, remember to select the appropriate provider number from the Requesting Provider dropdown or, if your organization has multiple providers, by searching.

Tips for using Authorization Manager more efficiently

1. Don’t enter the alpha prefix from the member ID number.
   • Exception: for Federal Employee Program members, the “R” is required.
2. Check the tool for the status of your request, even if you faxed it.
3. Use the tool to view your determination letter. To do this:
   • Go to the Correspondence section of the system
   • Find your patient
   • Click View to open the determination letter

Benefits of Authorization Manager

• Access the tool 24 hours a day, 7 days a week, both from the office and when working remotely.
• Search for member-specific authorization requirements by code. If a service requires prior authorization, submit using the tool.
• Upload documentation to support your requests.
• View the status of your requests, even when submitted by telephone, fax, Online Services, and vendors such as AIM Specialty Health.

Do you need additional support?

We have many tools available for you, including:

• User Guide
• Q&As
• Quick tips: Acute care hospitals, Home health care providers, physical & occupational therapists, and skilled nursing facilities, IVF, Medications, and Mental health providers.

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.

Why we request that you use a participating laboratory

Using a participating laboratory helps reduce health care costs in general and for your patients specifically.

• Non-contracted laboratories may charge substantially more than in-network (contracted) laboratories, leading to increased health care costs overall.
• Members may be subject to balance billing and, depending on their plan, could also be responsible for additional costs. These out-of-pocket costs often confuse members when they receive their explanations of benefits (Summary of Health Plan Payments).
• Contracted laboratories must meet rigorous credentialing standards, including accreditation from either the College of American Pathologists or a Clinical Laboratory Improvement Amendment (CLIA) certificate.
• Many of our contracted clinical laboratories have the ability to easily share patient results with your practice, such as integrating with your electronic medical record systems.

Steps you can take

1. Please review your office workflows to make sure you’re always referring to a contracted clinical laboratory as a first option.
2. You can find a participating clinical laboratory by using Find a Doctor & Estimate Costs. Enter "Clinical Lab" in the search window and choose the member’s network, then select Enter.

Questions?

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:

• Checking claim status (how to do it and what to look for)
• Submitting replacement claim tips
• Tracking your payments on Payspan
• Billing telehealth visits 
• Navigating Provider Central

Can’t join? We’ll post a recording

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.

Webinar recording, slides, answers to questions

• Recording of webinar
• Slides
• Answers to your questions

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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.

Register for an account

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.

Verify your practice tax ID

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.

Here are some tips to help you with the practice tax ID verification process. Be sure to:

• Include the prefix with the ID number (The prefix is the 3 characters that appear at the start of the ID number, for example, XXA123456789).
• Use claims from two separate patients.
• Use the total amount billed, not the amount paid, as reflected in the Provider Detail Advisory.
• Use finalized claims, not claims submitted the same day that you’re verifying, or use pretreatment estimates.
• Use claims with dates of service within 3,000 days.
• Do not use a claim that has been re-adjudicated.

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.

Tips for navigation

Now that you have registered for your Dental Connect account, here are some tips for successful navigation to save you time:

• Choose eligibility inquiry from the list of services on the home page. 
• Select Blue Cross Blue Shield of Massachusetts as the payer from the drop-down box.
• Enter the CDT code (for example, D1110 – Prophylaxis) rather than the service category to determine the benefit frequency.
• Use the “Claims History” link at the bottom of the page to quickly determine if your patient is currently eligible for a frequency-based benefit (for example, D0210 – Intraoral Complete series).

Questions?

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

The Betsy Lehman Center is a state agency that works to improve the safety of health care across the state.

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

How do I start?

If you’d like to request a peer supporter:

• Complete this form and someone from the Betsy Lehman Center will get back to you in 1-2 business days.
• Call the Betsy Lehman Center at 1-617-701-8101.

Thank you

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.

Resources

Virtual Peer Support Network information sheet

This article is for medical providers and their office staff.

We're continuing to update and streamline our Blue Book administrative manual. This month, we consolidated the professional and facility versions of the Billing & Reimbursement section. During the consolidation, we also:

• Moved claim tracking information to the Claim Submission page.
• Moved information about payments, advisories, and overpayments to the Payments & Correspondence page (login required; go to Office Resources>Billing & Reimbursement).
• Updated the How to correct rejected claims Quick Tip.
• Created a new Coordinating with Medicare fact sheet based on the previous Billing & Reimbursement section for facilities.

You can access the new Billing & Reimbursement document by logging in and going to Office Resources>Policies & Guidelines>Provider Manuals.

Read about other changes to the manual that we’ve announced already:

• Blue Book manual reorganized (April 18, 2018)
• Improving your experience accessing our policies (June 16, 2017)

MPC_103015-1B-23

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.

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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.

Vaccines and treatment: cognitive rehabilitation

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.

COVID-19 testing and care
Testing coverage

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.)

Diagnosis codes

We added the following codes that were effective January 1, 2021. Find the complete list on our COVID-19 Information page.

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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:

• A new temporary COVID-19 payment policy
• New COVID-19 lab testing codes
• Reminders about telehealth claim submissions

Temporary COVID-19 payment policy effective immediately

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.

What’s included in this new policy?

• Consolidated information that we previously published
• New information about:

• • Ambulance services
  • Autism services
  • Field hospital billing
  • Informational modifiers for reporting
  • New HCPCS codes for COVID-19 testing
  • Place of service billing
  • Specimen collection coding
  • Temporary documentation requirements for telehealth or telephone E/M visits

New COVID-19 lab testing codes

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. 

Fee schedules will be updated
We will update our professional, hospital outpatient, and clinical laboratory fee schedules accordingly.

Reminders about telehealth claim submissions

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:

• A telephone call in place of an office visit
• A virtual visit/video service

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.

• Modifiers (GT, 95, GO, GQ) are required on all video/telehealth claims. Please follow industry-standard practice of including the modifier on all lines of the claim form.
• Depending on your provider specialty, modifiers may or may not be required on claims for telephonic/telehealth visits. Please see our payment policy for details.
• Include the place of service.

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:

• Submit a replacement claim with changes for reprocessing.
• Use frequency code 7 and update the claim.

See our replacement claims page for more information.

Resources

• COVID-19 payment policy
• Laboratory and Pathology Payment Policy
• Replacement claims information
• COVID-19 Information page

Questions?

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

• You still need to notify us of all inpatient levels of care and submit the appropriate supporting documentation.
• While this notification-only requirement is in place, we will not perform medical necessity reviews for inpatient levels of care.
• Timely notification helps us to facilitate optimal care coordination, mobilize additional services to support transition-of-care and discharge planning, and ensure claims processing.
• This is an extension to the waiver that we announced on March 24 and was set to expire June 23, 2020. See COVID-19: Latest news (March 24).

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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:

• When drugs for the treatment of COVID-19 are covered
• When services associated with pharmaceutical treatments do not require a cost share

Commercial members: Managed care (HMO and POS), PPO, and Indemnity

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:

• Antiviral therapy (such as Hydroxychloroquine; the original Hydroxychloroquine policy still applies
• Immunomodulators (such as Dexamethasone)

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:

• Blood-derived products (such as SARS-CoV-2 immunoglobulins, Mesenchymal stem cells)
• Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors)
• Other therapies currently under investigation without published supporting evidence

Medicare HMO Blue^SM and Medicare PPO Blue^SM members

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

Resources:

• NIH guidance regarding treatments
• CMS press release on New Hospital Procedure Codes for Therapeutics in Response to the COVID-19 Public Health Emergency
• FEP COVID-19 Coronavirus Resource Center

MPC_030620-1N-109

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.

What to expect

• We will make every effort to credential providers within 72 hours from the date Blue Cross receives your application.
• Providers who are approved under this process will receive a Welcome Letter with their effective date. Provider Groups will also be notified daily via the established Massachusetts Hospital Association health plan enrollment notification process.
• Primary care providers will be given a ‘closed panel’ status so members cannot select them as their primary care provider during this temporary period.
• Approval under the Public Health Emergency Provider Credentialing and Enrollment Process is time-limited and pursuant to the Massachusetts state of emergency declaration.
• Providers who are credentialed under this Public Health Emergency Provider Credentialing and Enrollment Process will not appear in our Find a Doctor & Estimate Costs member directory until they have completed the full permanent credentialing process.

When the Massachusetts state of emergency is lifted

• We will notify you following the conclusion of the Massachusetts state of emergency end date of your time-limited credentialing and enrollment with us.
• If you would like to join the Blue Cross of Massachusetts network on a permanent basis you may initiate the full credentialing and enrollment process while concurrently submitting the Public Health Emergency Credentialing application for temporary enrollment. How to apply for full permanent credentialing.

Questions

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:

• All Blue Cross Blue Shield of Massachusetts products, except the Federal Employee Program (FEP). FEP follows Blue Cross Blue Shield Association referral and authorization guidelines. For more details, see fepblue.org.
  • In addition to waiving authorization requirements for inpatient acute and mental health hospital admissions, Medicare is also waiving authorization requirements for long-term acute care (LTAC) hospitals, acute and subacute rehabilitation (rehab) facilities, and skilled nursing facility (SNF) admissions.
• Both COVID-19 related and non-COVID-19 related inpatient admissions.
• Prior authorization and concurrent reviews for inpatient admissions and scheduled surgeries at inpatient acute care hospitals and mental health hospitals.

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.

What’s the requirement for other inpatient levels of care for commercial products?

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

Authorization requirements

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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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 for providers and laboratories

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.

Diagnosis codes

Symptomatic/No diagnosis yet

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:

COVID-19 diagnosis

If your patient has a previously confirmed COVID-19 illness or tests positive for COVID-19, use the codes below.

*The CDC has created an interim set of ICD-10 CM official coding guidelines, effective February 20, 2020.

Waiving member cost share

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.

For Federal Employee Program (FEP) members:

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.

Coverage and site of service expansion

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.

Telehealth and telephonic services

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:

• Practitioners must use modifier GT, 95, G0, or GQ (via synchronous/asynchronous telehealth audio and/or video telecommunications systems to differentiate a telehealth (telemedicine) encounter from an in-person encounter with the patient.
• When reporting modifier GT, 95, G0, or GQ the practitioner is attesting that services were rendered to a patient via synchronous/asynchronous telehealth audio and/or video telecommunications systems.
• If you are submitting 1500 claims using Direct Data Entry in Online Services, please do not use separate fields for each character of the modifier. The screenshot below shows the correct way to enter modifiers.
  
  
  

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:

For ancillary and a subset of behavioral health providers

Important note: This information only applies to the ancillary and behavioral health specialties on this list.

• When you provide any telephonic services, do not bill the specific telephonic CPT codes. Bill all covered services that you render either by telehealth/video or telephone as if you are performing a face-to-face service using the codes that are currently on your fee schedule.
• You must use one of the following telehealth modifiers listed above (GT, 95, G0, and GQ) and place of service 02. This will enable us to pay you the same rate we pay you for in-person, face-to-face visits.

Referrals and authorizations

Referrals and prior authorizations are not required for medically appropriate care for COVID-19.

Allowing early prescription refills

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.

Federal Employee Program (FEP)

For COVID-19-related benefit changes impacting the Federal Employee Program, please see fepblue.org/coronavirus.

Member coronavirus help line

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.

Questions?

Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).

Resources

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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:

• Retrospective provider audits for:
  • Professional providers
  • Inpatient and outpatient facilities
• Prepayment reviews for forensic claims
• Any other claim recovery activities

Questions?

Call Network Management and Credentialing Services at 1-800-316-BLUE (2583).

MPC_030620-1N-102

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.

Resources

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.

Questions

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.

Resources

The following guides and video demonstrations are available on our Authorization Manager page:

• Authorization Manager Quick Tip: Outpatient rehab and home health care
• Authorization Manager User Guide
• Home health care global - HMO/POS (3 min)
• Home health care initial - PPO (3 min)
• Physical therapy outpatient rehabilitation (3 min)
• Occupational therapy outpatient rehabilitation (3 min)
• Speech therapy outpatient rehabilitation (4 min)

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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.

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:

1. Search for a Subset (for example, “Asthma,”) by keyword or code.
   Click Find Subsets.
   
   
2. Double-click the name of the Subset to open the Notes view.


3. To access the InterQual criteria, click the Book View button at the bottom of the screen. You can print a SmartSheet to use for requesting authorization if you also see a Print Full Subset button. SmartSheets are available for hysterectomies, hip/knee replacements, and certain back surgeries.

The criteria included in the Transparency Tool appear in these Change Healthcare products:

* excluding chiropractic

Resources

• Authorization Manager, an eTool for checking authorization requirements, submitting requests, and checking the status of requests
• Medical policy site
• Federal Employee Program medical policies

 Authorization Quick Tip

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.

Resources

 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.

How to check if the member is eligible for acupuncture benefits

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’re reprocessing claims denied due to lack of referral

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.

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This article is for chiropractors.

By early September, 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.

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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.

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_053023-1S-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.

Dental clearinghouse alternatives

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.

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.

• Attend one of our training webinars, with sessions dedicated just to claim submission. Click here to register today!
• Watch our brief video, How to create a claim.
• Review our ConnectCenter claims quick tip.

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:

• Home page resources to help you monitor your overall claim activity
• Worklists to help you manage claims that need to be corrected and resubmitted
• A claim search tool that helps you quickly find a claim
• A new claim summary page that includes a visual Claim Tracker

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.

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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.

August: Getting preventive care

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.

July: Dental health and mental health resources

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:

• Depression
• Insomnia
• Social anxiety
• Stress, anxiety & worry
• Substance use

Early summer and spring topics

Our earlier Coronavirus member emails focused on:

• COVID-19 information and resources
• Stress and anxiety relief
• Health care savings
• Pharmacy mail options and discounts
• Pharmacy savings with PillPack

In-depth health news

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.

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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:

1. Go to Verification>New Eligibility Request.
2. Complete the required fields. It’s important to include the prefix with the member ID number.
3. For detailed benefits information, select a service from the Service Type dropdown menu. The default option, Health Benefit Plan Coverage, includes many common services.
4. Click Submit. Your results will appear at the bottom of the page.

Change what is displayed under "Eligibility" by using the Select View and Service Types Returned filters.

Frequently asked questions about benefits inquiries

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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 most claim inquiries, choose Claims>Claim Status and not Claim Search. (Claim Search is only for claims submitted in ConnectCenter.)

• The Claim Status page will provide basic information about any claim sent to Blue Cross Blue Shield of Massachusetts (including claims submitted through Online Services). For more detailed information, choose a method based on how you submitted your claim:
  • If you submitted your claim through Online Services, you will need to use the Customer Portal tool within ConnectCenter. Instructions are available on page two of the 1500 Claim Entry with ConnectCenter Quick Tip.
    
  • If you submitted your claim through ConnectCenter, refer to the Claim Status section of the ConnectCenter Quick Start.

• On the Claim Status page, be sure to enter the correct provider NPI in the Billing Provider area. The “billing provider” is the provider identified on the claim as receiving payment. The billing provider may have a group or individual NPI.
  

• Check your default providers in Admin>Provider Management. If you submit professional claims in ConnectCenter using Direct Data Entry, your default “Billing Provider” and your default “Requesting Provider” should be the same provider, as shown below:
  

Payspan is an option for processed claims

For processed claims, you can also use Payspan to learn the claim number, payment or denial details, and check information.

Resources

 ConnectCenter Quick Start
 1500 Claim Entry with ConnectCenter Quick Tip
 Checking Claim Status Quick Tip (includes Payspan information)

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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.

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.

Entering authorizations

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.

Entering referrals

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.

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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:

1. Go to Verification>Search Eligibility History.
2. If you would like to limit your results, complete a field such as Last Name. You can leave all fields empty if you choose. (Note that the default search limits your results to inquiries with a Requested Date in the previous 30 days.)
   
3. Click Search.
4. Click the link that says “Successful” in the row for the appropriate member.
   
5. Your results from that date of service will re-appear. (To perform a new eligibility inquiry, enter a new date of service.)
6. Open the “Select Transaction” menu. You can choose to enter a professional claim or a referral, or you can inquire on the status of a claim or referral. (For authorizations, use Authorization Manager.)
   
   
     The first time you create a claim for a patient, begin with eligibility results. Create future claims for the patient by copying a previous claim. (Be sure to choose a claim that was accepted by Blue Cross.) To do this, search for the claim by going to Claims>Claim Search. You can click the “Copy claim” icon in your results.
7. After you select a transaction, the "Use Member For" button will light up. Click the button to transfer the member’s information to the new screen.
   

Resources

For videos, quick tips, and webinar information, visit our ConnectCenter page and click on "Trainings and resources."

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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:

• create provider records that you can use throughout the application
• create provider defaults to maximize your efficiency.

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.

How to create provider records in ConnectCenter

1. From within ConnectCenter, go to Admin>Provider Management and click Create.
   
2. The Create/Edit Provider screen appears. You will be prompted to enter an ID number. Enter the provider’s NPI and hit the Tab key on your keyboard. This will check the NPI you provided against the National Plan and Provider Enumeration System (NPPES).
     If the NPI is found in the NPPES registry, data from the registry will be populated into ConnectCenter. If the data from the registry is out-of-date, you can and should correct it.
3. Enter or correct provider details as needed.
4. Look for the section marked “Set Provider As Default.”
   • To use the provider as a default provider for real-time transactions (benefits, eligibility, and claim status), click the check box, “Requesting Provider.”
   • To use the provider as a default in 1500 claim submissions, check “Billing Provider” or “Rendering/Performing Provider.”

Click Save to use the provider information in your transactions.

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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:

• the dates of a service year
• the number of visits allowed and remaining.

The Coverage Status area

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.

View Options

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:

• Combined benefits for physical and occupational therapy
• A benefit limit of 60 visits per calendar year
• 60 visits remaining

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 ConnectCenter^TM, 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:

• Check Blue Cross member eligibility and benefits
• Verify claim status
• Enter and verify referrals
• Submit 1500 claims

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:

• Quick Start Guide
• Quick tips on provider management, claims, and checking claim status
• Links to live webinar trainings offered by Change Healthcare, an independent company that developed this online tool 
• Best practices
• Tips for common transactions

  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:

• Submit your claims using a format modeled after the 1500 claim form
• Receive immediate prompts while building your claims to help reduce claim entry errors

   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:

• July 22 for claim submission
• August 12 for eligibility, claim status, and referrals
• After August 12, you will be able to access historical claims using the ConnectCenter Customer Portal Reporting & Analytics link

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

• Notify anyone within your organization and billing agency about this change and revise any office workflows
• Attend one of our training sessions to learn how to navigate ConnectCenter and take advantage of its new features
• Begin using Authorization Manager to enter or check the status of authorization requests for inpatient or outpatient authorizations (see Resources section below to learn more). ConnectCenter does not have any authorization entry or verification capabilities. 

Resources

• ConnectCenter webinar trainings 
• News article: Updates to ConnectCenter training
• Authorization Manager (tool for entering authorizations)
• ConnectCenter

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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.

* For general ConnectCenter support, please call Change Healthcare at 1-800-527-8133.

Resources

To help you with this transition:

• Watch our brief videos, How to create a claim and How to work with Online Services claims.
• Review our ConnectCenter claims quick tip.
• Read our July 27 article, Online Services claims and timely filing reports in ConnectCenter.
• Many other resources to help you get started with ConnectCenter are available on our ConnectCenter eTools page.

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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.

What this means for you

Starting January 1, 2022, you must:

• Verify your directory information every 90 days
• Update your information when it changes, including if you come in or leave the Blue Cross network

How to update your information

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.

What happens if my information is not verified on time?

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.

Questions?

If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.

MPC_052620-1Q-18

This article is intended for dental providers caring for our members

We’ve renamed the team of associates who respond to calls from dental providers. Formerly known as the Dental Information Center, this team of associates now answers to Dental Provider Services.

We’ve updated Provider Central with this change. Our online Dental Blue Book will be updated in 2020.

You can answer most questions with our provider etools

Before you call Dental Provider Services, remember that you can use our provider etools to resolve many issues. Our Dental Connect technology allows you to: 

• Verify member eligibility and benefits
• View member benefit dollars used to-date and deductible remaining, if applicable
• Obtain claim status, including pending claims
• Create reports.

And you can manage your payments using Payspan, our free, secure, web-based system for tracking and managing Electronic Funds Transfer (EFT) payments and claims data. Benefits of using Payspan include the ability to:

• Access funds three business days after claim is finalized
• View your Provider Payment Advisories (PPAs) and Provider Detail Advisories (PDAs) online
• Search for payments and 18 months of claim history
• Reduce mail and trips to the bank.

Billing electronically reduces administrative costs and paperwork for your office and improves the accuracy of billing and posting information. If you prefer not to use an electronic clearinghouse to submit your claims, you can set up electronic data interchange with us through our Direct Connection tool.

Please call Dental Provider Services at 1-800-882-1178 if you have questions about member benefits, eligibility, or claims.

MPC_082119-2D-2

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.

Assistance with PPE costs

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 4^th 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.

Preventive dental visit time limits eased

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 .

Billing for telephonic services

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.

• Report virtual consultation services using CDT code  D0140 (Limited Oral Evaluation – Problem Focused).
• Virtual consultations should be patient-initiated and related to a specific dental problem which would otherwise have required an in-person office visit.
• In the patient’s chart, please document the problem that necessitated the telephone or video consultation and what you recommended to the patient. 

Billing for emergent care needs

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.

Blue Cross contributes to Massachusetts Dental Foundation’s COVID-19 Recovery Fund

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.

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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

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This article is for dentists and oral surgeons caring for our members

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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:

• 2022 Dental Blue Book
• CDT Dental Procedure Guidelines and Submission Requirements
• Pediatric Essential Health Benefits Dental Procedure Guidelines and Submission Requirements
• Dental Fee Schedules ()

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:

• Dental Fee Schedules (log in and go to Office Resources>Billing & Reimbursement>Fee schedules)
• 2023 Dental Blue Book
• CDT Dental Procedure Guidelines and Submission Requirements 
• Pediatric Essential Health Benefits Dental Procedure Guidelines and Submission Requirements

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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.

• Go to Dental Connect for Providers and click Register for Dental Connect
• Enter partner code BCMA01DPS (this is an important step for registration; Blue Cross Blue Shield of Massachusetts sponsors monthly fees for this service for Blue Cross of Massachusetts members)
• Learn more about Dental Connect’s current features.

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:

• Claims history. Check the last time a procedure was performed. For example, you can check when the member had their last cleaning and full mouth x-rays.

• Check benefits. You can look up specific benefits by service type or by entering the specific CDT procedure codes. For example, you can look up the member’s benefit for periodontics by choosing “periodontics” from a pull-down menu or by entering in a periodontal procedure code, such as D4910.

• View benefit frequency limitations. Our benefit response has been enhanced to include frequency limitations that are part of a member’s benefit design when you enter a service by the specific CDT procedure code (for example, D2750 crown benefit is one time per 60 months).

• Deductible remaining. You can view member benefit dollars used to-date and deductible remaining, if applicable.

Contact us for a live demo

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:

• 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 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.

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:

1. Tracking claims submitted using Online Services will take more steps after August 12, when we retire Online Services. Learn about how you will access Online Services claims on page two of our 1500 Claim Entry Quick Tip.
2. Submitting claims in ConnectCenter early allows you to take advantage of new claim tracking features. The benefits of ConnectCenter include:
   • Home page resources—for example, a pie chart—to help you monitor your overall claim activity
   • Worklists to help you manage claims that need to be corrected and resubmitted
   • A claim search tool that helps you quickly find a claim
   • A new claim summary page that includes a visual Claim Tracker
     
     

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.

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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:

• the primary insurer’s name and address
• the insured member’s ID number for that insurer
• and if the claim was
  • paid by the other insurer, report the amount paid at the claim’s line level. We recommend contacting your practice management software vendor to ensure each claim line being reported has either the primary insurance paid amount or reject reason.  Your claim may be rejected if this data is not supplied.
  • denied by the primary insurer, report the reject reason.

You can learn more on our dedicated coordination of benefits page, including a member fact sheet and information about:

• Determining which payer is primary
• Submitting claims when there is more than one payer
• Handling rejected claims
• Submitting claims when Medicare is primary

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This news article is intended for physical therapists, occupational therapists, and speech-language pathologists

It’s here! Beginning July 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), 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.

Questions?
Please contact Network Management Services at 1-800-316-BLUE (2583).

MPC_120117-2V-3

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).

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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.

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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.

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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.

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 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.

Questions?

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.

• Wednesday, November 22, 2023
• Friday, December 22, 2023
• Friday, December 29, 2023

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.

• Thursday, November 23, 2023
• Friday, November 24, 2023
• Monday, December 25, 2023
• Monday, January 1, 2024

Happy holidays, and as always, thank you for the care you provide to our members.

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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.

Video: A physician’s perspective on 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.

Articles and videos: How the vaccines work

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.

Web page: Coronavirus resource center

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.

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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:

• Claims History. Check the last time a procedure was performed. For example, you can check when the member had their last cleaning and full mouth x-rays.

• Check Benefits. You can look up specific benefits by service type or by entering the specific CDT procedure codes. For example, you can look up the member’s benefit for periodontics by choosing “periodontics” from a pull-down menu or by entering in a periodontal procedure code, such as D4910.

• View benefit frequency limitations. Our benefit response has been enhanced to include frequency limitations that are part of a member’s benefit design when you enter a service by the specific CDT procedure code (For example, D2750 crown benefit is one time per 60 months).

• Deductible remaining. View member benefit dollars used and deductible remaining, if applicable.

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!

Contact us for more help

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:

Out-of-state providers should call their local Blue Cross plan.

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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.

Thank you for providing all records when requested

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.

Improve your administrative efficiency

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.

Other types of requests we now send to you:

Questions?

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.

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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:

• Remote access (preferred option)
• Fax
• Email
• Mail
• Secure file transfer protocol (SFTP)

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.

Questions?

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.

Resources

• February 2nd announcement: HEDIS 2021 medical record collection begins now
• October 16th announcement: Preparing for HEDIS 2021 medical record collection      

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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.

Submission options

If you have not submitted your records, please do so using one of the following options:

• Remote access (preferred option)
• Fax
• Email
• Mail
• Secure file transfer protocol (SFTP)

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.

Questions?

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.

Resources

• Reminder: HEDIS 2022 medical record collection begins now
• Preparing for HEDIS 2022 medical record collection       

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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.

Submission options

• Remote access (preferred option)
• Fax
• Email
• Mail
• SFTP

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.

Questions?

If you have any questions about HEDIS, please call 1-888-99-HEDIS (43347). To set up remote access, please contact:

• Karen Sulham at 1-617-246-4409, or
• Shanshan Liu 1-617-246-7914.   

Thank you in advance for responding promptly to this request.

Resources

• Preparing for HEDIS 2023 medical record collection

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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.

Verify that your information is correct

To validate the information on our website:

1. Go to Find a Doctor & Estimate Costs.
2. Fill in your name or your facility name and zip code.
3. Enter a network (example: HMO Blue) and click Search.
4. Review the information for all your site locations.*

   Be sure to validate:
   Addresses Board certification Gender Hospital affiliations Languages spoken	Medical groups Phone numbers Specialties Whether you are accepting new patients Whether you offer telemedicine

   *Only addresses where members can make appointments will display in the directory.

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.

If you need to update your information, refer to the following.

We’ll continue outreach this Fall

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.

Questions?

If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.

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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.

Alternative home health care and hospice providers in our networks

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.

What happens to patient currently receiving care from HealthAlliance?

Patients currently receiving services from HealthAlliance may be eligible to continue in-network care with HealthAlliance.

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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.

What this means for you

You are required to:

• Verify your directory information every 90 days
• Update your information when it changes, including if you come in or leave the Blue Cross network

How to update your information

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.

What happens if my information is not verified on time?

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.

Questions?

If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.

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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:

• When entering a member’s ID number, don’t include the three-letter prefix, unless it’s a single letter “R” for FEP members.
• When entering both the Requesting Provider and Servicing Facility information, use your inpatient Provider Number when submitting inpatient requests, and outpatient Provider Number when submitting outpatient requests.
• Using the wrong Provider Number for the level of care you are requesting results in a mismatched authorization case.

Advantages of using Authorization Manager – start today!

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:

• Search member-specific authorization requirements by code.
• Check the status of requests regardless of how they were submitted.
• Upload additional clinical documentation to an existing case.
• Enter a transaction within minutes. By the time you call and talk to a service representative, you could have entered an authorization request!

Resources

• Authorization Manager User Guide
• Authorization Manager Provider Central page, which contains helpful tips, guides, and video demonstrations
• Authorization Manager tips for mental health providers
• Authorization Manager tips for Licensed Applied Behavior Analyst (LABA) providers

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.”

Questions?

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 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.

We’re here to help

• If you need help with or have questions about Authorization Manager, email us at HMMAuthorizationManager@bcbsma.com
• For clinical inquiries on InterQual^®, email us at MSKInterqual@bcbsma.com

More resources

• Authorization Manager Provider Central page, which contains helpful tips, guides, and video demonstrations
• Authorization Manager User Guide

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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:

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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:

• For urgent requests: Please fax your request to 1-888-282-0780 (preferred) or call 1-800-327-6716. (Please note that call hold times are longer than normal.)
• For requests that will not impact patient care this week: Please hold all authorization requests until we resolve these issues. We fully expect to resolve them this week.
• Referral entry is not impacted by this issue. Please continue to use Online Services to enter referrals.
• Please continue to use Online Services and Authorization Manager to check the status of existing referrals and authorizations.

Thank you for your patience. We will notify you as soon as these issues are resolved.

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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.

For claim submission

Real-time transactions

The remaining Online Services functions—benefit and eligibility inquiries, claim status, and referrals—will be discontinued after Friday, September 30.

Patient Lists for claims

If you use the Patient List feature in Online Services, it’s important that you:

• Perform eligibility inquiries for your patients in ConnectCenter before the claims functionality in Online Services is discontinued
• Include the patient’s first and last name in your ConnectCenter eligibility inquiries

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.

Need help?

• Change Healthcare’s ConnectCenter support is available at 1-800-527-8133
  • Select option 2 for claims or claim status
  • Select option 4 for eligibility
• Within the ConnectCenter application, you can request help by going to Help>Create a Support Ticket
• For help with Provider Central, please contact Blue Cross Blue Shield’s EDI/Provider Self-Service Support Team at providercentral@bcbsma.com or 1-800-771-4097, option 2

Resources

• For more about using the Eligibility Search History tool, read our June 16 article, “ConnectCenter Tips: Patient information”
• ConnectCenter Quick Start Guide
• 1500 Claim Submission in ConnectCenter Quick Tip
• Our ConnectCenter page

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This article is for all medical providers, office staff, and billing services that use Online Services

We had announced that ConnectCenter^TM  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.

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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:

Respond to Inovalon quickly

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.

Important to know

• Your contract requires you to respond to requests for all medical records, including both in-state and out-of-state Blue Cross members.
• Requests from Inovalon are in addition to other medical record requests we conduct.

How to submit records to Inovalon

If you have questions about delivery options or methods, please call
1-844-682-9764.

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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:

• A list of the new primary and specialty mental health care provider groups that you can refer your patients to
• Helpful resources to share with your patient, including a link to our member MyBlue Mental Health Options page 
• Authorization, medical necessity details, and payment information
• Our Mental Health Brief archives

Please visit and share this helpful resource with your colleagues and office staff.

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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.

How will my patient benefit from Team Blue Care?

By engaging with our Team Blue Care app, your patient can:

• Access personalized health and wellness content
• Chat with care managers about their specific health needs
• Set daily reminders for medications, appointments, and exercise
• Track progress toward their health goals, including daily steps and medication doses

Do I need to do anything?

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.

Questions?

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.

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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. 

What this means for you

You are required to:

• Verify your directory information every 90 days.
• Update your information when it changes, including if you come in or leave the Blue Cross network.

We’ll work with you to update your information

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.

What happens if my information is not verified on time?

Under CAA, we are required to remove provider practice locations from our directory whose location data we are unable to verify within 90 days.

Questions?

If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.

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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.

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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. 

What this means for you

You are required to:

• Verify your directory information every 90 days.
• Update your information when it changes, including if you come in or leave the Blue Cross network.

How to update your information

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.

What happens if my information is not verified on time?

Under CAA, we are required to remove from our directory provider practice locations whose data we are unable to verify within 90 days.

Questions?

If you have questions, please email us at ProviderDirectoryInfo@bcbsma.com.

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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. 

What this means for you

You are required to:

• Verify your directory information every 90 days.
• Update your information when it changes, including if you come in or leave the Blue Cross network.

How to update your information

• 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 Costs provider directory.

Keep in mind, contractual changes may require you to submit more information. Please review the forms here.

What happens if my information is not verified on time?

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.

Questions?

If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.

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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.

Save time by reviewing 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.

Review in a few minutes

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.

Questions?

If you have questions, email us at ProviderDirectoryInfo@bcbsma.com.

Resources

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.

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This article is for pediatricians, family medicine doctors, and dentists.

Please register to attend a live webinar about the HPV vaccination given by:
Katherine Dallow, MD, MPH Vice President and Medical Director, Clinical Programs and Strategy and Robert Lewando, DDS, MBA Executive Director, Professional Services, Dental Blue of Massachusetts.

During the webinar, you’ll learn:

• How dentists can help support HPV vaccination adoption
• The importance of your HPV vaccine recommendation
• Tips for how to talk to your patients about the vaccine

We’ll be sure to leave time for questions.

Register for the webinar
Please let us know if you will attend the webinar by registering below. We’ll need attendee name and information about your practice or organization, such as NPI and specialty. Please be sure to also register your office staff under your registration type on the second page.

Register now

How to access the webinar

As always, thank you for the care you provide to your patients—our members.

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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:

• checking authorization requirements or submitting them for certain services (AIM Specialty Health, Authorization Manager, Chiro Authorizations)
• checking benefits and eligibility (Dental Connect and Online Services)
• getting electronic payments for your claims (Payspan)
• understanding how a claim will process (Clear Claim Connection)
• setting up a direct connection with us.

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.

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This article is for dentists and oral surgeons caring for our members

Join us for an upcoming webinar featuring Dental Connect.

Who should attend?

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.

During the webinar, you will learn:

• How to register for Dental Connect
• How to navigate the tool easily

Dental Connect gives you 24/7 access to:

Please make sure you're receiving our emails so you receive all of the registration information.

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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

Who should attend?

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:

• How to register for Provider Central
• How to navigate the tool and the many resources available

Reserve your spot by registering here.