What's new

Our new chatbot is now live on our provider website! It is designed to provide you with quick and easy access to the information and support you need, 24/7. Our chatbot is available on the Contact Us and Self-Service Tool pages. Click the Provider Chat button to launch the chatbot.

Easily navigate to resources, forms and information
Chatbot can save you time and effort by providing you with quick and easy access to the information and support you need. Our provider chatbot:

• Is available 24/7, so you can get the information you need at any time and at your convenience
• Provides accurate and up-to-date information, so you can trust the answers you receive
• Can help you navigate to the information you need quickly and easily, saving you time and effort

Examples of how our chatbot can help
The chatbot can provide guidance on the following frequently asked questions:

• Claims mailing address (for example, ask “billing address”, “where can I mail claims”, “claims address”, etc)
• How to submit a claim (for example, ask “file claim”, “submit reimbursement request”, “reimburse me”, “submit bill”, “where can I get a claim form”)
• How to locate a claim not on file (for example, ask “I can’t find my claim”, “where’s my claim”, “did you get my claim”, “missing claim”)
• Which networks are currently open to credentialing (for example, ask “can I contract with you”, “I want to be credentialed”, “I want to sign up as a provider”, “how do I start credentialing”, “is my specialty available to contract”)
• How to validate or update provider directory information (for example, ask “am I in a member’s network”, “find a provider”, “how do I check my information”, “is my clinic in network”, “list of neurologists”, “what networks am I contracted with”)

Future capabilities
We are committed to continuously improving and expanding the capabilities of our chatbot. In the future, you can expect the chatbot to be able to help:

• Submit a pricing dispute or appeal
• Check pre-authorization requirements
• Find your contracting or credentialing status
• Determine how to submit pre-authorization requests

In the future, our chatbot will be able to route you to live chat with one of our Provider Contact Center representatives if you need further assistance. Additionally, the chatbot will be integrated with Availity Essentials, allowing you to access your Availity account and perform such tasks as checking claim status and submitting pre-authorization requests.

We hope you find the chatbot to be a valuable resource.

12/12/2024

Effective January 1, 2025, the following update will be made to the list of preventive care services covered at no cost to Individual and group plan members with Affordable Care Act (ACA) preventive benefits:

• Anemia screening: The U.S. Preventive Services Task Force (USPSTF) does not routinely recommend iron screening for pregnant women. Therefore, we are removing “anemia screening” from the Pregnant members section of our preventive care lists. A complete blood count (CBC) test will remain eligible for no cost-share for pregnant members.
• General health panel (CPT 80050): The USPSTF does not routinely recommend this panel’s lab components for the general population. We will cover this general health panel as a preventive benefit only in specific clinical settings, when a component of the lab could be considered preventive (e.g., for newborns for a thyroid stimulating hormone in context of newborn screening or a CBC for pregnant women).

Our preventive care list will be updated in January to reflect these changes.

12/4/2024

We recently emailed a survey to some of our participating primary care and behavioral health providers.

As a reminder, if you received the survey, please complete it by December 31, 2024. The survey should take less than two minutes to complete.

We value your efforts to effectively coordinate care for your patients with both medical and behavioral health care needs. We want to better understand your process for sharing clinical information. We are conducting this brief study to determine your satisfaction with the timeliness, frequency and overall level of care coordination with other providers.

12/4/2024

Our annual retrospective medical record review for commercial plans starts on December 4, 2024. In the next few months, you may receive medical record requests from Advantmed or Episource to complete this review. We appreciate your prompt response to all requests.

As a reminder, you are required to provide medical records for this review free of charge as part of your agreement with us. Learn more about our risk adjustment program, including best practices, tips and education resources.

12/4/2024

Beginning January 1, 2025, Blue Cross Blue Shield Federal Employee Program® (BCBS FEP) Member and Provider Customer Service call center hours will no longer include a mid-day closure. The Provider Customer Service call center’s updated hours will be Monday through Friday from 8 a.m – 5 p.m. (PT).

12/1/2024

Medicare providers and suppliers, including pharmacies, must not bill Qualified Medicare Beneficiaries (QMBs) for Medicare Part A or Part B cost-sharing. This includes Medicare Part A and Part B deductibles, coinsurance and copayments.

The QMB eligibility group is a Medicaid eligibility group through which states pay Medicare premiums and cost-sharing for certain low-income QMBs. The group is part of the Medicare Savings Programs.

Compliance reminder

All Original Medicare (also called Fee-for-Service Medicare) and Medicare Advantage providers and suppliers must:

• Ensure that QMBs are not billed for Medicare cost-sharing
• Take action to remedy any QMB billing or collections

To comply with these requirements, Medicare providers and suppliers should:

• Implement processes that avoid QMB billing prohibitions
• Make sure their office staff and vendors are using systems to identify the QMB status of Medicare beneficiaries

Read the MLN fact sheet for reminders and to learn how to be compliant.

11/7/2024