We strive to offer our members the latest in proven medical technologies by reviewing current scientific evidence and considering expert physician opinion when we develop our medical policies. We incorporate input from the Massachusetts Medical Society, specialty societies, national technology review organizations and community physicians in the development and review of all policies.
The purpose of our medical policies
The purpose of our medical policies is to provide guidelines for determining coverage criteria for new and evolving medical and behavioral health technologies, including procedures, equipment, and services.
Medical policy does not override the health insurance contract that defines members’ benefits, nor is it intended to dictate to providers how to practice medicine. Physicians and other health care providers are expected to exercise their medical judgment in providing the most appropriate care.
How you can review and comment on an individual medical policy
|Step||Go to the BCBSMA medical policy library and search for the policy of interest.|
|Step||Email comments on the policy to our E-Blue Review team at email@example.com. Or, send a fax to 617-246-7084.|
Please note: This is not a private email box. Do not send any identifying patient information in your email. The Medical Policy Administration mailbox is only for comments and recommendations of participating ordering providers on medical policies. The Medical Policy Administration mailbox cannot address questions regarding benefits, claims, billing, payment, reimbursement, appeals, individual case exception review, advance determination, prior authorization, or reconsideration review.
How to take part in a medical specialty-based review of our medical policies
Each month, our Medical Policy Group meets to review the policies for a specific specialty as listed in the review schedule shown below. The packet of policies for each specialty is available for review and comment beginning in the first week of the month shown.
Monthly medical policy group meetings
If you are a contracted clinician you may attend and participate in a specialty meetings listed below. Most meetings are held from noon to 2 p.m. in conference room 12-I at 101 Huntington Ave, Suite 1300, Boston, MA.
A conference call line is also available if you cannot attend in-person. To attend the meeting, either in-person or via conference call, please email firstname.lastname@example.org and we will send you a packet of information.
|Orthopedics, Rehabilitation Medicine and Rheumatology||June 30, 2020||12 –2 pm||Conference call|
|Psychiatry and Ophthalmology||July 28, 2020||12 –2 pm||Conference call|
|Cardiology and Pulmonology||August 25, 2020||12 –2 pm||Conference call|
|Urology and Obstetrics/Gynecology||September 29, 2020||12 –2 pm||Conference call|
|Gastroenterology, Nutrition and Organ Transplantation||October 27, 2020||12 –2 pm||Conference call|
|Plastic Surgery and Dermatology||November 17, 2020||12 –2 pm||Conference call|