Insurance Updates Week of August 7, 2017

By Policy and Advocacy Brief posted 16 days ago

  

Anthem Blue Cross Blue Shield

Provider remittances

Beginning in August of 2017, paper provider remittances will have updated information on them to make it easier for providers to identify and track refunds and recoupments. The new section titled “Negative Balanced Deferred” will be listed under the recoupment notification of the remittance. This will allow providers to identify overpayments that have will be recouped in the future. If providers have any questions about this change, they are requested to call the number at the bottom of the recovery letter or remittance.

Provider Maintenance Forms

Anthem is committed to ensuring that their provider directories are up to date. They are requesting that any provider making changes to their practice to complete the Anthem Provider Maintenance Form. All areas of change such as adding or deleting a physician, address changes or change of phone numbers can be cone on this form.

Prior Authorization for Genetic Testing

As of July 1, 2017, all genetic testing authorizations should be submitted to AIM. This process can be done via telephone, the web portal or directly accessing the AIMP Provider Portal. For more information, please click here.

First Coast Service Options

ABN Modifiers

There are two modifiers specifically to use on claims when an ABN form is initiated. These modifiers are:

  • GA waiver of liability statement on file
  • GZ item or service expected to be denied as not reasonable or necessary

Failure to report modifier GA may result in the provider assuming financial responsibility for the denied service even though the practice had the patient sign the ABN form. Modifier GZ may be used in instances where a signed ABN is not obtained from the patient; however when modifier GZ is billed, the provider assumes financial responsibility if the service is denied.

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