fep blue durable medical equipment providersruth putnam the crucible

Updated References section. P ;77=A#7cA^5{o\"NT0lNQ2&*= /'vG~pY~*WO) I FEP Blue Focus: Is an in-network-only benefit program that requiresmembers to use PPO providers in order to receivebenefits. Updated References section. Penalty Note: You must obtain prior approval for these services. P | fep blue durable medical equipment WebDurable Medical Equipment when provided by a Durable Medical Equipment Provider and when prescribed by a Physician, is limited to the most cost effective Durable Medical Equipment that meets the members needs as determined by Florida Blue. The Best's Rating Report(s) reproduced on this site appear under license from A.M. Best and do not constitute, either expressly or implied, an endorsement of (Licensee)'s products or services. MEDICARE AND BLUE WebFor us to service your call better, please have your Plan ID number and claimant information readily available when you place your call. =j !d:Up"EP [y: Organization . MPTAC review. Durable Medical Equipment Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Virginia For us to service your call better, please have your Plan ID number and claimant information readily available when you place your call. Does Blue Cross Blue Shield Cover incontinence supplies? The documentation substantiates that the physician exercised prudent clinical judgment to order or provide this equipment for an individual for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and in accordance with generally accepted standards of medical practice. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Claims Submission Map This document shall not be construed to require coverage for any device when the FDA has determined its use to be contraindicated. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Whether or not the requested item is considered a piece of DME. See the current Standard and Basic Option Service Benefit Plan brochure External Link for additional information. Any other printing, copying or distribution is strictly prohibited. Covered items include: Home dialysis equipment ; Oxygen equipment ; Hospital beds ; Wheelchairs ; Crutches ; Walkers ; Continuous passive motion (CPM) devices ; Dynamic orthotic cranioplasty (DOC) devices ; Insulin pumps Alternatively, commercial or FEP plans or lines of business which determine there is not a need to adopt the guideline to review services generally across all providers delivering services to Plans or line of businesss members may instead use the clinical guideline for provider education and/or to review the medical necessity of services for any provider who has been notified that his/her/its claims will be reviewed for medical necessity due to billing practices or claims that are not consistent with other providers, in terms of frequency or in some other manner. endobj We use cookies on this website to give you the best experience and measure website usage. 2023 Government Employees Health Association, Inc. All rights reserved. L5980. Customer Service. When services may be Medically Necessary when criteria are met: Customized durable medical equipment, other than wheelchair, Note: applies to any code for durable medical equipment when there is not a more specific document available. 2019 Blue Cross Blue Shield Association. L5321. Also, the manner in which the equipment or device will restore or improve the bodily function should be explained. Mental Health and Substance Use Disorder Benefits, 5(h). MPTAC review. Webdoctors visits, durable medical equipment and more You pay a monthly premium for this plan. Durable Medical Equipment | Durable medical equipment is any equipment that meets all the following requirements: Moreover DME must meet the following definitions of durable and medical equipment: Durable medical equipment is considered medically necessary when all of the following criteria are met: The information should include the individuals diagnosis and other pertinent functional information including, but not limited to, duration of the individuals condition, clinical course (static, progressively worsening, or improving), prognosis, nature and extent of functional limitations, other therapeutic interventions and results, past experience with related items, etc. Beginning January 1, 2022, we will make changes to our Federal Employee Program Standard Option, Basic Option, and FEP Blue Focus plans. L5845. Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus WebWe have three prescription drug programs: Whats Take a look atBlue Cross and Health and wellness updates For our pregnant Standard and Basic Option members, were updating the items included in the Pregnancy Care Box offered Outpatient sleep studies performed outside the home Required for sleep studies performed in a providers office, sleep center, clinic, outpatient center, hospital, skilled nursing facility, residential treatment center and any other location that is not the members home. Use the drug authorization table below to determine if you need an authorization. Benefit Description December 30, 2021. % A$dlx,=%mDg -m]:]\q|CF/zupY z|2`TfC%P0Su$wYu&1(fuUZ%/U!=qN_/^8ZqIx7EUU#5b(LR,Q$S$^>x]fX?pE|3-'P463F&~"]L") Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., Wellmark Blue Cross and Blue Shield of South Dakota, and Wellmark Administrators, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Please contact the local Blue plan where the service is provided. Speech-generating devices, limited to $625 per calendar year, 5(a). L2628. You will receive a written response within 15 calendar days of receipt of the request. Defined abbreviation in clinical indications criteria section. For more information, call 877-342-5258, option 3. Surgical services See the FEP Blue Focus Service Benefit Plan brochure External Link for details on the following surgeries: Include applicable diagnoses, procedure codes, and medical information with your prior approval request form. WebWe have three prescription drug programs: Whats Take a look atBlue Cross and Health and wellness updates For our pregnant Standard and Basic Option members, were updating the 1-703-729-4677. Offers unique design with services categorized by core,non-core, and wrap benefits. | 8VI,&vvVoXX+!C0`PxI.|QaL'. Medical foods covered under the pharmacy benefit Required. Previously, there was no benefit for this procedure. Updated Websites.   Your member ID card is your key to using your medical plan benefits. WebFor Preferred providers $6,000 Self Only / $12,000 Self Plus One / $12,000 Self and Family; for Non-preferred providers $8,000 Self Only / $16,000 Self Plus One / Blue The following durable medical equipment (DME) codes will require prior authorization (PA) effective August 1, 2023. Benefits Section 5(a). Removed ICD-9 codes from Coding section. Section 5 (a). Espaol | Best's Ratings are under continuous review and subject to change and/or affirmation. For more details, refer to the medical policy PDF File PDF File. For more information, view our privacy policy. All rights reserved. GEHA Durable Medical Equipment (DME) - FEP Blue Focus 2023 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. 101 Huntington Avenue, Suite 1300, Boston, MA 02199-7611, Changes to our Federal Employee Program (FEP) for 2022. Clinical trials for certain organ/tissue transplants Contact our Transplant Clinical Trials Information Unit at 800-225-2268 for information or to request prior approval. WebDurable medical equipment and prosthetics and orthotics: For authorization determinations (PDF) Inpatient medical admissions Submitting acute inpatient authorization requests: Frequently asked questions for providers (PDF) Inpatient authorization requests: Tips for using the e-referral system Blue Cross PPO (PDF) CareFirst The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. We now offer kidney transplants as part of the Blue Distinction Centers for Transplants Program. Standard and Basic Option prior approval list, Alaska precertification/concurrent review request form, Washington precertification/concurrent review request form, (Eastern) Washington ABA prior approval form, complies with applicable Federal and Washington state civil rights laws. 2020 . Blue Update Websites and References. Please review the terms of use and privacy policies of the new site you will be visiting. 2022 Blue Cross and Blue Shield Service Benefit Plan - L5701. L5981. Nipple reconstruction after a mastectomy for female to male gender reassignment surgery. Beginning January 1, 2022, we will make changes Well notify you of any impacts or changes as we learn of them. Available at. Y &hq0mv6pnS`OH_~H~06x_VZzd*G/0[! FEP Prior Approval Lists and Forms | FEP | Premera Blue Cross Reformatted Coding section. Find A Doctor Provider Directory - FEP Blue Precertification Request for Authorization of Services. Ting Vit | We no longer offer pancreas transplants under the Blue Distinction Centers for Transplants Program. National Coverage Determination: Durable Medical Equipment Reference List. Prescribed by your attending physician (i.e., the physician who is treating your illness or injury); Primarily and customarily used only for a medical purpose; Generally useful only to a person with an illness or injury; Used to serve a specific therapeutic purpose in the treatment of an illness or injury. 1 For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. H {company} is responsible for the content delivered on its website, including terms of use 2022 MEDICARE & BLUE Blue Cross and Blue Shield Service . Medical Services and Supplies Provided by Physicians and Other Healthcare ProfessionalsDurable Medical Services and Supplies Provided by Physicians and Clarified Note in clinical indication section. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. This document defines general principles used to determine the medical necessity of durable medical equipment (DME) and includes a general definition of DME, Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. and privacy policies that govern the site. Commercial only. Provider Monday thru Friday 8:00 a.m. - 3:30 p.m. Eastern Standard Time (EST) Health Benefit Plan. Provides therapeutic benefits or enables the individual to perform certain tasks that he or she is unable to undertake otherwise due to certain medical conditions or illnesses; Is primarily and customarily used to serve a medical purpose; Generally is not useful to a person in the absence of an illness or injury; Is appropriate for use in the home but may be transported to other locations to allow the individual to complete instrumental activities of daily living (IADL), which are more complex tasks required for independent living. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Prosthetic devices (external) and specialty DME Includes but not limited to specialty hospital beds, deluxe wheelchairs, power wheelchairs, mobility devices including scooters, microprocessor limb prosthesis, electronic and externally powered prosthesis and related supplies. 2023 Wellmark Inc. All rights reserved. L5979. Providers should review the list of codes that will require PA. Anthem 2022 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 11 0 R 13 0 R 16 0 R 18 0 R 19 0 R 20 0 R 21 0 R 23 0 R 24 0 R 25 0 R 26 0 R 28 0 R 30 0 R 32 0 R 35 0 R 53 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The BlueCard Program is a national program that enables members obtaining healthcare services while traveling or living in another Blue Plans area to receive all the same benefits of their contracting Blue Reconstructive surgery for conditions other than breast cancer, Orthognathic surgery procedures, bone grafts, osteotomies and surgical management temporomandibular joint (TMJ), Other hip, knee, ankle, spine, shoulder, rhinoplasty, septoplasty, varicose vein, and all orthopedic procedures using computer-assisted musculoskeletal surgical intervention. Pre-certification is also required if the service or procedure requires an inpatient hospital admission. WebDurable Medical Equipment (DME) Specialty Prior approval is required for all specialty DME to include: Specialty hospital beds Deluxe wheelchairs, power wheelchairs, and mobility devices and related supplies Gene Therapy and Cellular Immunotherapy Prior approval is required for all gene therapy and cellular immunotherapy, including: Car-T All current Service Benefit Plan contract holders will receivereplacement member ID cardsin the mail in the first few months of 2022. Section 5 (a). To request a review of medical necessity and FEP benefits: Gene therapy and cellular immunotherapy Required. Commercial only. Centers for Medicare and Medicaid Services. Heres everything you need to know about it. Wellness and Other Special Features, 5(i). ) #C|'aMTK-\=yBfCN>iX|kl_ 4Cf%%"RmQFF8JK. WebFind the best doctors, clinics, specialists and hospitals outside the U.S. Our overseas network includes over 14,000 providers. You will receive a written response within 15 calendar days of receipt of the request. Verify benefits and benefit exclusions. Enter your email address to sign up for the Health e-Report, WebCall the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Section 5. WebDurable Medical Equipment when provided by a Durable Medical Equipment Provider and when prescribed by a Physician, is limited to the most cost effective Durable Medical WebDurable Medical Equipment (DME) 2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. Medical Plans Elevate High Deductible Health Plan (HDHP) Standard Option Elevate Plus High Option Dental Plans FEDVIP Standard Option FEDVIP High Option Connection Dental Plus Tubeless insulin delivery systems under the Tier 2 and Tier 3 pharmacy benefit. Visit medicare.gov to see the 2020 monthly premium Part C Medicare Advantage L5210. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). WebDurable Medical Equipment (DME) 2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus. Contact Us - National Association of Letter Carriers Health *BuI0 @P,{dnz7&:DUm@E@% JT| www.fepblue.org . Employee Program (FEP) Prior Approval/Pre WebChanges to our Federal Employee Program (FEP) for 2022. Medical Services and Supplies Provided by Physicians and Other Healthcare Providers. BLUE Note: When selecting a Blue Distinction Center, please confirm the Blue Distinction Center facility or provider is in your health plan network. 3 0 obj ftypjp2 jp2 jpxbjpx rreq @ - -jp2h ihdr d 8 colr jp2cOQ / 8 d R \ #B@ H H P H H P H H P H H P H H P Blue The requested item meets the definition of DME above; The requested item has not otherwise been identified as not medically necessary or investigational and not medically necessary by a specific document; There is adequate documentation in the medical records or in the claim submission of. L5050. 2 results found for search term : durable medical equipment Medical Policy Guidelines This document defines general principles used to determine the medical necessity of durable medical equipment (DME) and includes a general definition of DME, which is based on standard contract definitions of DME and the definition from the Centers for Medicare & Medicaid Services (CMS). Wellness and Other Special Features, 5(i). Under GEHA's plans, you are NOT This article is for all providers caring for our members. Durable Medical Equipment A.M. Best is not responsible for transcription errors made in presenting Best's Rating Reports. WebCall the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. jP MPTAC review. Web1-800-360-7654 or 1-202-479-6444. Please check appropriate state mandates for laws that will supersede this document when applicable, such as those governing prosthetics. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option External Link plan and the FEP Blue Focus External Link plan. Previously, these items were covered when ordered through CVS Caremark. Please note the following Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals. Available at: Centers for Medicare and Medicaid Services. Instrumental activities of daily living (IADLs): Activities related to independent living and include preparing meals, managing money, shopping, doing housework and using a telephone; IADLs do not involve personal care activities. L5613. Visitors to this web site are authorized to print a single copy of the Bests Rating Report(s) displayed here for their own personal use. for the services or content delivered on or through {domain}, including the terms of use and privacy policies that govern the site. Professional paper claim form (CMS Updated Description and Websites. All Networks. WebFEP Blue Focus is a PPO with a nationwide network including hospitals, physicians, and numerous ancillary/specialty providers. For FEP Blue Focus only, we now offer a breast pump and milk storage bags under our maternity benefit, for members who are pregnant or nursing when ordered through our fulfillment vendor. Make copies of relevant billing and benefits statements. WebAlaska ABA prior approval form (Eastern) Washington ABA prior approval form Durable medical equipment (DME) prior approval forms Alaska DME prior approval form Washington DME prior approval form For services outside Alaska or Washington Please contact the local Blue plan where the service is provided. This requirement applies to both the physician and facility services. }o|/SJ^="=?[ *'3TC;NaD +VK5lL]$NV>zNOs1d^gt)~;W{$6.OvUY4!T\8AD! Deutsch | MPTAC review. Be sure to check your coverage manual to find out if you must go to a Blue Distinction Center for certain procedures to be covered. The medical necessity of DME is based on an analysis of the following factors: Activities of daily living (ADLs): Self-care activities such as transfers, toileting, grooming and hygiene, dressing, bathing, and eating.

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