Provider Central

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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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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This article is for acute care hospitals and surgical day care centers caring for our members
Please share with relevant office staff and billing agencies

As you know, we partner with Equian, a national payment integrity vendor, to review select inpatient facility claims on a pre-payment basis. Effective November 4, 2024, Equian will change the mailing addresses that you use to submit necessary information for them to complete their reviews. Their electronic contact information will not be changing.

Please refer to the table below and notify any relevant office staff and billing agencies of this change.

If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.

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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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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.
• Email: HMMAuthorizationManager@bcbsma.com.

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

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This article is for providers who use Authorization Manager for musculoskeletal services

Thank you for using Authorization Manager to submit your requests for musculoskeletal services. Here are some tips to help you avoid unnecessary delays with your submissions.

InterQual criteria

You must select the applicable InterQual^® criteria in each section of your request. In the below example, a specific diagnosis is required to meet the criteria for a hip replacement. However, since the diagnosis noted is “none of the above,” the request will pend for additional clinical information to confirm that the member’s diagnosis supports the need for the procedure.

If you have questions about which category a diagnosis falls into, please email us at MSKInterqual@bcbsma.com.

Level of care requests

Total joint replacement surgery for hips or knees is generally considered a SDC (surgical day center) outpatient procedure. In some situations, an inpatient request may be appropriate if there are comorbidities that support the need for an inpatient level of care.

If your request does not indicate any comorbidities that support the need for inpatient surgery, it will pend for secondary medical review. Please consider whether the procedure can be done at the outpatient level of care. If any complications or changes in the member’s status arise after you’ve obtained an authorization, you may fax us a request to change the level of care.

See the example scenario below where there are no comorbidities selected, meaning the request will pend.

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 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 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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This article is for providers caring for our Medicare Advantage members

CMS has announced a significant expansion of its auditing efforts for Medicare Advantage plans. The agency is several years behind in completing Risk Adjustment Data Validation (RADV) audits and is investing resources to expedite completion.

Audits are underway for all eligible Medicare Advantage contracts, including Blue Cross Blue Shield of Massachusetts, with a focus on risk adjustment data validation for payment years 2019 to 2024.

Why it matters: The number of records audited per health plan is increasing from 35 to 200 annually, making timely compliance crucial.

• How you can help: If you receive a letter requesting medical records, it’s imperative to respond promptly by the deadline listed. As contracted providers, you are required to validate diagnosis codes used in the Medicare Advantage risk score calculation.

• What the data is used for: The Medicare Advantage RADV program is CMS’ primary method to ensure accurate payments to Medicare Advantage plans. CMS conducts these RADV audits to confirm that the diagnoses submitted support the risk-adjusted payments.

What's next: We will be sending medical request letters this month. Your prompt reply is essential to ensuring compliance with this audit.

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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 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

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In celebration of national oral health month this June, we want to thank you for delivering exceptional customer service and dental care to your patients–our members. We are committed to helping ensure that both you and our members have all the resources needed to achieve great oral health.

Your work in educating patients about the importance of oral health and its connection to overall health has inspired us to better support our members. For example, our Enhanced Dental Benefits offer additional preventive and periodontal services to members with chronic conditions where oral health is crucial to their overall health management. As a result of your efforts to improve your patients’ oral and medical health, a majority of our eligible members have taken advantage of these extra services.

And as a reminder, our dedicated team of Dental Network Managers is available to meet with you at your convenience–either in-office or virtually–and may stop by just to say thank you for all that you do for our members. You can reach your Dental Network Manager by calling 1-800-882-1178, option 4, and then selecting the appropriate region:

• South Shore / Cape Cod Region select 1
• North Shore / New Hampshire select 2
• Boston / Metro West select 3
• Central and western Massachusetts / Dental Schools select 4

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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

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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

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This article is for chiropractors.

This month, chiropractors will receive their annual performance reports. The report compares care you provide to that of your peers and can be a useful tool in understanding your practice patterns.

The independent company that administers our chiropractic authorization program, WholeHealth Living, Inc., a Tivity Health company, developed these and will be mailing them in the middle of June. If you have questions about your report, you can call WholeHealth Living at 1-866-656-6071.

Learn more about the chiropractic authorization program

Refer to our Chiropractic Services page for information about members included in the chiropractic authorization program, how to request authorization, and more.

Thank you for the care you provide to your patients—our members.

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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.

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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.

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This article is for all providers caring for our members

Thank you for continuing to use Authorization Manager as the most efficient method to submit and review authorization requests, available 24/7. We understand that when you are searching for the provider in your request, you may not always see the correct address listed. Please be aware that this is normal, and that you do not need to call us. Below are some guidelines to help you determine which Provider ID to select.

We’re here to help

If you need help with or have questions about Authorization Manager, email us at HMMAuthorizationManager@bcbsma.com.

Resources

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

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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 medical providers caring for our members

If you attended our October 16 “Everything you need to know about claims” webinar, we hope you learned some tips and best practices on how to efficiently do business with us. Whether or not you attended, you can reference the below resources.

• Webinar recording
• Slide deck
• Questions and Answers

We also sent out an email to everybody that registered for the webinar with a link to a feedback survey. As always, we appreciate your comments and questions. Stay tuned for future webinars!

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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.

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This article is for all professional providers caring for our members

The Massachusetts Division of Insurance (DOI) requires us to monitor our network and notify them of contracted providers that participate in a concierge model. The DOI also requires us to clearly identify those concierge providers in our provider directory. In accordance with your provider agreement, you are required to give us 90 days’ advance notice when transitioning to a concierge model.

What’s a concierge provider?

Concierge providers offer extra services not covered by the health plan and may require patients to pay a one-time or periodic fee.

Notification requirements

• Send an email to NetworkManagement@bcbsma.com at least 90 days before establishing a concierge model. Please include the names and NPIs for the providers in the practice.

• Notify your patients of the changes and explain how it will impact them to allow them enough time to decide whether they will remain with the practice.

Our Concierge Provider Fact Sheet offers guidance on notifications for you and your patients.

Questions?

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

MPC_060525-3W-1

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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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

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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 providers who use ConnectCenter through Provider Central.
Please share this information with others in your organization who use ConnectCenter.

We’re pleased to let you know that ConnectCenter* is now available for self-service access to:

• Claim status inquiries
• Claim submission (professional 1500 claims) and tracking
• Member benefits and eligibility verification
  
• Referral submission and verification

Thank you for your patience as we worked to restore access to this eTool.

If you and your organization already use other tools to perform the tasks listed above, you may continue to do so but know that ConnectCenter is now also an option.

How to access ConnectCenter

Log in to Provider Central and go to the ConnectCenter page in eTools.

Need a refresher on how to use ConnectCenter?

We offer quick tips, videos, and other resources to help support your use of the tool. It’s all here on our ConnectCenter page. The Quick Start Guide is a good place to start.

Note: Dental Connect remains unavailable. We’ll be in touch with more details on access to this eTool for dental practices.

*ConnectCenter is owned and maintained by Optum, Inc., an independent company that offers this tool to our network of providers.

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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.

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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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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.

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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 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.

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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 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 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 providers who use Authorization Manager for musculoskeletal services

Thank you for using Authorization Manager to submit your requests for musculoskeletal services. As a reminder for epidural steroid injection (ESI) requests, please select the appropriate frequency based on the following criteria.

Transforaminal ESIs: In a single session, you should perform either a 1-level, bilateral transforaminal ESI or a 2-level, unilateral transforaminal ESI.

Interlaminar and caudal ESIs: In a single session, you should perform a single, 1-level caudal or interlaminar ESI.

Additional reminders for all ESIs:

• We cover a maximum of four sessions per six-month period and six sessions per 12-month period regardless of the number of injections performed during each session.
• We cover a maximum of four sessions per spine region per year (cervical and thoracic is one region, and lumbar and sacral is one region).
• Transforaminal injections should not be given with caudal or interlaminar injections in the same session.

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

We’re excited to host our annual Yankee Dental conference this year from January 30 to February 1, 2025! If you’ll be attending in-person this year, we hope you’ll stop by booth number 610 to speak with your Dental Network Management team. Below are some of the topics they can talk to you about:

• How your practice can join our different networks to improve patient access to care
• How to save time by using our online CDT Lookup tool in Provider Central
• Expanded dental benefits for Medicare Advantage members
• Enhanced dental benefits for members with certain health conditions

As a reminder, our Dental Network Managers offer both in-office and virtual consultations to help you resolve any questions or concerns you may have. You can reach your Dental Network Manager by calling: 1-800-882-1178, option 4, and then selecting the appropriate region:

South Shore / Cape Cod Region select 1
North Shore / New Hampshire select 2
Boston / Metro West select 3
Central and western Massachusetts / Dental Schools select 4

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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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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.

MPC_052620-1Q-17

This article is for providers and discharge planners who refer our members for home health care services in Central Massachusetts.

HealthAlliance Home Health & Hospice, Inc. is leaving the Blue Cross Blue Shield network as of August 31, 2022. Effective September 1, you’ll need to refer new patients to a participating in-network provider for home health and hospice services.

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

MPC_030822-2N-8-ART

This article is for all providers caring for our members

If you have patients with out-of-state Blue plans (known as BlueCard members), you don’t have to call that other plan to request authorization. Instead, you can use the single sign-on Electronic Provider Access (EPA) tool directly from Provider Central.

The EPA tool allows for an easier and more efficient way to submit requests for BlueCard members. By entering the three-character prefix from the member’s ID card, you will be automatically routed to their Blue plan’s EPA landing page. This page will connect you to the plan’s available electronic pre-service review options.

To access the EPA tool, log in to Provider Central, click on eTools>Pre-service review for BlueCard members, and then click Go Now.

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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.

MPC_062321-2L-40

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 the health care physicians, clinicians, and office staff caring for our Medicare Advantage members.

We’re pleased to introduce the 2024 Medicare Advantage 5-Star Provider Playbook to support you and your office staff in caring for Medicare Advantage patients.

Download your 5-Star Provider Playbook

This resource guide is designed to provide you with actionable, evidence-based information, tips, and best practices to help you coordinate your patient’s care and improve health outcomes. The Playbook:

• Defines Star measures and who the measures affect
• Suggests CPT codes to use as applicable
• Provides recommended best practices to close gaps in care
• Describes patient experience surveys that CMS conducts annually with Medicare beneficiaries and recommends best practices to improve performance.

Achieving high Star ratings is a collaborative effort

We hope this Playbook serves as a resource to support your quality and patient experience improvement efforts. Working together, we can achieve a CMS 5-Star quality rating to give our members—and your patients—the value they deserve from their health plan.

When Star Ratings improve for our Medicare HMO and PPO plans, our members benefit by:

• Getting screening, tests, vaccines, and other preventive services for early detection of disease
• Better managing their chronic conditions
• Having an improved experience with their provider and health plan.

And when you participate in a health plan with a high star rating, it shows that you, too, have achieved high standards.

For more information

To learn more, visit our dedicated CMS Stars page or if you have questions about Blue Cross Blue Shield of Massachusetts and the Star Rating Program, please contact:

• Adam Licurse, Senior Medical Director, Population Health & Analytics, Health and Medical Management
  Adam.licurse@bcbsma.com

• Heidi Parrilla, PhD, Associate Director, Medicare Stars
  Heidi.parrilla@bcbsma.com

• Jason B. Ruda, MS, CPXP (Certified Patient Experience Professional), Associate Director, CAHPS Strategy and Improvement
  Jason.ruda@bcbsma.com

Thank you for your ongoing efforts to improve quality

We value your partnership and look forward to continuing to work with you to improve the quality of our Medicare Advantage members’ health care and their overall experiences with the health care system.

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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. We recommend assigning someone in your office to manage all provider directory activities—including attesting in CAQH Provider Data Portal or responding to Blue Cross surveys every 90 days. 

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 the CAQH Provider Data Portal. CAQH also sends email verification and re-attestation reminders.

If you are a dentist, facility, group practice, or lab, we’ll ask you to complete a survey each quarter to validate your information. We’ll send you an email or letter on how to access the survey when it’s your time for review.

Dentists: Our dental survey campaign launched in June and is open until July 16th. Click “Dental Providers” below to review. Note: Clicking the link below will re-direct you to our directory survey on Alchemer. Please enter your NPI as the password.

For other types of changes, including changes to your contract or leaving the Blue Cross network, please review the forms here. If you are a dental provider that needs to report this information, you are advised to contact your dental network manager.

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.

MPC_052620-1Q-61

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

Provider directories are important to helping patients find the care they need. Therefore, it’s important you keep your directory information accurate and up to date.

The Consolidated Appropriations Act (CAA) requires provider directory information to be verified every 90 days. Providers and health insurers have roles in fulfilling this requirement to maintain an accurate directory. 

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.

MPC_052620-1Q-46

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. Regulations require us to ensure providers verify directory information every 90 days. We recommend collaborating with someone in your office to manage your provider directory activities—including attesting in the CAQH Provider Data Portal or responding to Blue Cross directory validation surveys every 90 days.

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. 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 directory survey each quarter to validate your information. We’ll send you an email or letter on how to access the directory survey when it’s your time for review.

Reminder: New data fields in CAQH Provider Data Portal

Massachusetts is now requiring additional information about your practice and facilities. These new fields will capture additional information, such as:

• ADA accessibility features
• Age groups treated
• Appointment availability
• Demographics about patients you treat
• If practice specializes in treatment of genders and gender identities
• If  practice specializes in the treatment of specific populations or cultural groups
• Languages spoken
• Office locations and operating hours per location
• Practice group affiliation
• Telehealth availability

For facilities and other health care providers such as group practices, we’ll add these new data fields in the Blue Cross directory review surveys that we send to you later this year.

Learn more with Mass Collaborative resources

The Massachusetts Health & Hospital Association, the Massachusetts Medical Society, the Massachusetts Association of Health Plans, Healthcare Administrative Solutions (HCAS), CAQH and the Massachusetts Division of Insurance hosted a training webinar in January to support this transition. See links to their resources below.

We appreciate your collaboration

We understand these requirements may add to your administrative workload, and we truly appreciate your attention to this matter. We thank you for your collaboration and help in ensuring our members—your patients—can find the care they need.

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This article is for office staff caring for our members
Please share this with anyone at your practice or organization who may be interested in joining

When a patient enters your practice seeking care, a positive experience helps build trust and increases the likelihood that they’ll follow through on their treatment plan. At Blue Cross, we recognize the importance of each patient interaction; therefore, we want to work with you to learn and share best practices in our new Patient Experience Champions League.

What is the Patient Experience Champions League?

In this program, we’re asking organizations or practices to appoint a Patient Experience Champion to participate. The Champions will attend monthly Zoom meetings—hosted by Blue Cross—on patient experience improvement. It’s also a chance to learn and network with colleagues in the industry. Read more about the program in our fact sheet.

Who is a Patient Experience Champion?

A Champion is a member of the frontline staff or a practice manager. They are a high-performing member of the team appointed by leadership to support patient experience initiatives within the organization or practice. Please speak to your leader before registering if necessary. 

Watch our video below to learn more about the Champions League!

Register to join today!

We hope that you’ll join us in this collaborative effort to improve patient experience. Our first session is Tuesday, February 18, 2025, Noon - 1p.m. where we’ll focus on how patient experience:

• Impacts clinical outcomes and quality care
• Can improve employee and provider experience
• Influences CAHPS scores—and what CAHPS scores tell us

 Please use the button below to register. We’ll send the Zoom webinar link to all registrants.

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This article is for all medical providers caring for our members

Looking for tips and reminders on how to efficiently do business with us? Join us for a claims overview webinar designed for all medical providers and their office staff!

   Date: Wednesday, October 9, 2024  Wednesday, October 16, 2024

  Time: 1 p.m. – 2 p.m., ET

Our experts will cover these topics and more:

• Checking claim status
• Confirming medical necessity and billing guidelines
• Provider Central overview
• Submitting replacement claims
• Verifying appeal status

If you’re unable to attend, we’ll post a recording of the webinar onto Provider Central afterwards.

Register today!

Please register for the webinar by Friday, October 4. You’ll need to enter your name and information about your practice or organization, such as NPI and specialty.

Additionally, you may submit questions (not about specific claims or members) through the registration survey. By receiving your questions in advance, we will be able to prepare comprehensive responses to best help you.

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Carelon Medical Benefits Management is updating its website to enhance your experience entering authorizations for sleep testing and treatment services. Their ProviderPortal is expected to be upgraded on September 1, 2025.

Carelon Medical Benefits Management, an independent company, administers the sleep management program on our behalf.

Why does this matter to you?

This change will alter your experience entering authorizations. To help you prepare, Carelon is offering several webinar trainings.

Learn about Carelon’s newest ProviderPortal features, view a demo, and get your questions answered in these sessions.

Register for a webinar

Resources

• Visit the Sleep Management page
• Enter authorizations in Carelon (log in is required to take you directly to ProviderPortal)
• Access resources on the Carelon Medical Benefits Management site 

MPC_052725-2M-1-ART

This article is for all providers caring for our members

To help you get quick and convenient access to information about your patient’s eligibility, benefits, and claims, we offer a number of technology tools through our website. To see what we offer and how to use those tools, you can now access information about the tools without logging in on our eTools page.

You’ll find descriptions of our web-based technologies for:

• 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.

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

Join us on February 21 at 1 p.m. for a Zoom webinar that will teach you how to:

• View and download your 2023 fee schedules
• Register for Provider Central
• Navigate the resources available on our website.

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.        

Reserve your spot by registering here.

MPC_010323-1P-6

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

To help you prepare for our switch to ConnectCenter for real-time transactions (eligibility and claim status) on September 30, we’ve added more ConnectCenter learning opportunities. You can learn about the most relevant functions for you:

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

At least two webinars are offered each week between now and our final transition to ConnectCenter. To help you get the most out of the presentation, we recommend that you review our tips before you connect to the meeting.

If you’ve already attended a training but would like to refresh your understanding of specific topics, our eTools page now features brief (under 15 minute) videos highlighting many different features of ConnectCenter.

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This article is for all providers caring for our members

When we communicate with providers about training opportunities, federally mandated initiatives, or contractual changes, we frequently find that many aren’t receiving our initial email or the confirmation of their registration for events. For this reason, we ask you to check your junk or spam folder to ensure that our emails from the following addresses are delivered to your inbox:

Blue Cross Blue Shield of Massachusetts: email@contact.emailbcbsma.com
Registration for webinars and surveys: noreply@alchemer.com

While the process may vary depending on your email system, in general to unblock an email address you can:

1. Open your junk or spam folder
2. Right click on a message from the sender whose messages you want to have in your inbox
3. Select "Not junk" or "Not spam"

You can also refer to these how-to tips from common email systems

How to unblock Blue Cross in Outlook
How to unblock Blue Cross in Gmail

Contact your IT administrator should you have any questions.

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July 21, 2022 update: We have postponed the date for Online Services retirement. Read more.

Based on feedback from providers, we’ve created a training opportunity specifically to help mental health providers make the switch to ConnectCenter. The session will be held on May 26 from 10:30 a.m. - 12:00 noon. 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.

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

We hope you can join us on May 26!

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No member cost for these telehealth services

This is a reminder that effective January 1, 2021, we are waiving cost share (copayment or
co-insurance) for Medicare Advantage members who receive telehealth services for the following types of services:

• primary care visits
• specialist visits when treatment is related to COVID-19
• urgent care visits
• outpatient mental health visits

Cost share will apply for all other telehealth visits, such as physical therapy visits.

Send Medicare COVID-19 vaccine claims to original Medicare

This is a reminder that coverage for the COVID-19 vaccine and administration, or antibody infusion treatment for your Medicare Advantage patients, is covered through original Medicare.

You must submit claims for COVID-19 vaccine and administration or antibody infusion treatment to the CMS Medicare Administrative Contractor (MAC) for payment—not to Blue Cross.

Resource

CMS: Medicare billing for COVID-19 Vaccine Shot Administration

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This article is for all providers caring for our members

We are aware of the worldwide Microsoft outage. Blue Cross Blue Shield of Massachusetts systems and applications are not affected by this issue. Our provider partners should be able to conduct business with us normally.

For those hospitals impacted by this outage, we are temporarily waiving prior authorizations, concurrent reviews, and hospital admission notification requirements. We ask impacted hospitals to notify us as soon as possible that a Blue Cross member has been admitted and that you notify us when your system issues are resolved to reduce the risk of claims payment disruptions.

MPC_071924-1Y

This article is for all providers caring for our members

Administering the COVID-19 vaccine to as many people as possible will play a significant role in overcoming this public health crisis. Although the approved vaccines are demonstrated to be safe and effective, we understand that some of your patients may feel hesitant. That’s why we’re doing all that we can to reduce vaccine hesitancy by keeping our members informed.

Monthly emails

We’ve been sending monthly emails since January to encourage members to get ready for their turn to get the vaccine.

For example, in our March 2021 email, we’re letting readers know:

• The vaccine is fully covered with no cost.
• Vaccines are FDA-approved and have undergone rigorous clinical trials with over 70,000 people.
• The vaccines are available in phases based on age, health status, and occupation.
• More than 720,000 Massachusetts residents have already been vaccinated.

Our emails also include frequently asked questions and answers as well as a video from health care providers at the Dimock Center on getting the vaccine.

MPC_080320-1Y-2

This article is for providers who perform ABA services

We previously gave you some tips on how to request Applied Behavior Analysis (ABA) services via Authorization Manager. Here are some more useful reminders:

• Submit all ABA requests via Authorization Manager, even if the request is for treatment.
• When submitting each request, you must upload the ABA Service Request Form to Authorization Manager.
• For assessment, be sure to submit all requests using only CPT code 97151. If your request is for treatment, include the treatment codes only on the ABA Service Request Form, not on Authorization Manager.
• Enter the ABA behavioral analysis group (BAG) number as the servicing provider, facility, and the requesting provider.
• Please fax your request to us only in these situations:
  • Twins and multiple births. At this time, Authorization Manager will not return eligibility if the patient has a sibling with the same birth date.
  • Federal Employee Program (FEP) members with out-of-state plans. We need to manually enter these members into our system.

Watch this short video demonstrating the step-by-step process of how to submit a request for ABA services in Authorization Manager.

As a reminder, all providers are required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax as of 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!

Resources

• Applied Behavior Analysis Service Request Form
• Authorization Manager Tips- Applied Behavior Analysis (ABA)
• Authorization Manager User Guide
• Authorization Manager Provider Central page, which contains helpful tips, guides, and video demonstrations

Questions?

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

MPC_012618-1L-104-ART

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

We're adding new opportunities for you to learn about ConnectCenter, our new online portal for real-time transactions and claim submission. These sessions have targeted content so that you can learn about the functions of ConnectCenter that are most relevant to your work. Pick a webinar focused on:

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

Newly added webinars will be held on May 31, June 1, June 7, June 14, June 15, July 6, July 7, August 3, and August 17, in addition to webinars already scheduled for May-August. To help you get the most out of the Webex, please review our tips before you connect to the meeting.

In addition, our ConnectCenter page now features brief (under 15 minute) videos highlighting many different functions of ConnectCenter.

If you’ve already attended a webinar, you may find the focused sessions with a new trainer helpful, or you can brush up your knowledge with one of the videos on our eTools page.

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