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2021 E / M (Evaluation and Management) Updates

Having questions about the 2021 E&M guideline changes for office visits?

January 5, 2021

Question: Since history and physical exam are no longer required to level the visit, should I still document these elements? Answer:  Yes. Although history and physical exam are no longer required to level the vi…

Understanding the Complexities of Each Defined Condition & How to Document

December 22, 2020

Self-limited or minor problem: A problem that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status. Stable, chronic illness: A problem with an expected dur…

2021 E&M Guideline Changes

December 11, 2020

E&M changes in 2021 overview

Insurance Updates

Excellus Physical, Occupational, and Speech Therapy Preauthorization Process Change

February 25, 2021

MVP COVID19 Testing Update

February 25, 2021

MVP Health Care® (MVP) covers the cost of COVID-19 testing that has been deemed medically necessary at no cost share to the members.   MVP does not, however, reimburse for COVID-19 tests performed on an…

MVP Prior Authorization for Musculoskeletal Surgery Updates

February 25, 2021

Effective January 1, 2021, MVP Health Care® (MVP) is updating the Magellan Healthcare™ Utilization Review Matrix for Musculoskeletal Surgery of the Spine, Hip, Knee, Shoulder, and Interventional Pain Mana…

MVP COVID19 Vaccine Reimbursement and Coding

February 25, 2021

COVID-19 Vaccine Reimbursement and Coding MVP Health Care® (MVP) is covering approved COVID-19 vaccines at no cost-share to Members in all plans. Please follow the guidance below when submitting for reimbursement …

Excellus New Group Membership Notice

February 25, 2021

Effective January 1, 2021, several groups transtioned from Lifetime Benefit Solutions to Excellus BCBS. Please reivew all Member Cards for eligibility and benefits at each visit.

Administrative Policy AP-26 COVID-19 Viral and Antibody Testing and Supplies – Diagnosis Code B97.29

February 25, 2021

For claims billed on or after February 1, 2021, to remove interim diagnosis code B97.29 (Coronavirus as the cause of diseases classified elsewhere).  This update applies to all lines of business and is in line with …

Effective March 1st: UnitedHealthcare Community Plan of NY has a new requirement for Primary Care Provider Referral to Specialist

February 23, 2021

Please read the attached FAQ from UnitedHealthcare Community Plan of NY regarding their new referral process for members in need of services from a specialist provider. All in-network providers and UnitedHealthcare Commu…

Excellus BlueCross BlueShield Reinstating Reimbursement for Preventive Health Visits for Children and Adults via Telehealth During the Public Health Emergency

December 31, 2020

Excellus stresses that this is an option, not a requirement, and they strongly encourage in-person visits whenever possible, consistent with recent recommendations from the Centers for Medicare & Medicaid Services …

Notification to Providers Regarding Changes to Compliance Certification Requirements Pursuant to New York State Social Services Law (SOS) §363-d

December 30, 2020

UnitedHealthcare Temporary Prior Authorization Program Changes-- COVID-19

December 22, 2020

SNF prior authorization: UnitedHealthcare is suspending prior authorization requirements for admission to in-network SNFs. Transfer prior authorizations: UnitedHealthcare suspending prior authorizationrequirements w…

Coding Updates

Telehealth Grid

December 3, 2020

Documentation: Patient initiated and consent (written or verbal) Same as any face-to-face patient encounter, with the addition of the following: A statement indicating the service was provided via telehealth: P…

ICD-10 Codes- COVID-19

March 2, 2021

As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) is implementing additional codes into the International…