In addition to the summary of monthly changes below, please also review our monthly Bulletin for recent and upcoming changes to our medical and dental policies, and associated changes to pre-authorization requirements. The Medical Policy Manual includes a list of recent updates and archived policies.
Commercial and Uniform Medical Plan Pre-authorization List
Added CPT codes effective June 1, 2020:
Genetic Testing; Preimplantation Genetic Testing of Embryos (Genetic Testing #18)
- 81228, 81229
New medical policies replacing MCG guidelines
Two new medical policies have been developed to replace the current MCG guidelines used to review Hysterectomy and Ultrasonic Bone Growth Stimulators. Please see the June 1, 2020, issue of The Bulletin for details and policy effective dates
To see how a medical claim will pay, access the Clear Claim Connection tool on the Availity Provider Portal.
Revised dental reimbursement policies effective June 1, 2020:
- Cytology Sample Collection (Oral and Maxillofacial Surgery #47A)
- Dental Accident (Miscellaneous #67A)
- Frenulectomy (Oral and Maxillofacial Surgery #53)
- Laser Treatment for Restorative Procedures (Miscellaneous #66)
- Multiple Surface Restorations, Same Tooth (Miscellaneous #67B)
- Non-Reimbursable Dental Services (Miscellaneous #70)
- Temporomandibular Joint Dysfunction (Miscellaneous #68)
- Tongue Thrust Therapy (Miscellaneous #67)
Read the June 2020 issue of our newsletter for details.
In 2019, we partnered with Quartet, a mental health technology and services company, to give primary care providers (PCPs) in specific counties in western Washington an easy way to refer members to mental health care. Quartet’s services are now expanding to providers throughout the state of Washington, with recent growth in the central part of the state. This service is free for both providers and members.
Through Quartet, PCPs can:
- Easily refer their patients to a mental health provider (MHP) based on their patient’s needs, preferences and insurance
- Collaborate with the MHP on a patient’s treatment
Proactively screen patients to identify those who may need mental health support
As Quartet expands, they are welcoming new providers to sign up and use the platform. Signing up is easy, and using the platform is free!
PCPs, here’s how to get started with Quartet:
- Reach out directly to Quartet’s general manager, Jackie Longmire, at email@example.com or 1 (626) 392-6825.
Or visit the Quartet website to sign up. Someone will be in touch with you shortly.
Note: Quartet is available to MHPs in the Regence BlueShield network who wish to receive referrals from Quartet at no cost. To sign up, visit Quartet’s website.
Effective June 11, 2020, we will change how we determine the effective date for new providers joining an existing contracted group.
Participation effective dates
If you are a newly credentialed provider joining an existing contracted group, upon the approval of your credentialing, the effective date of your participation will be the date your credentialing application is considered complete, which is determined as part of the credentialing approval process.
We suggest that you hold claims for your Regence patients until after you receive notification of approval so claims will be paid at the in-network rate and won’t have to be reprocessed.
Note: The effective date will continue to be based on when the agreement is signed for new-to-Regence providers.
Learn more about the contracting and credentialing processes, including how to determine your effective date and how to sign up for eContracting.
We publish updates to medical policies, dental policies and Clinical Position Statements in our monthly publication The Bulletin.
We provided 90-day notice in the March 2020 issue of The Bulletin about updates to our Intensity Modulated Radiotherapy (IMRT) of the Thorax, Abdomen, Pelvis, and Extremities (Medicine #165) medical policy, effective June 1, 2020.
You can read issues of The Bulletin or subscribe to receive an email notification when issues are published on our website. The Medical Policy Manual includes a list of recent updates and archived policies.