August 10, 2009

BC-09-11
HP-09-08
SA-09-10
MS-09-10

HHA-09-08
DC-09-08
ASC-09-09

Cindy Garrison, Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Blue Cross and Blue Shield of Kansas Medical Policies

As you know, BCBSKS publishes medical policies for new and existing procedures throughout the year.  Some of the reasons for developing and implementing medical policies include
•           being good stewards of member dollars,
•           leveling consistent coverage guidelines to all provider types, and
•           proper administration of selected benefit options.

Most medical policies include a listing of covered diagnoses; however, medical justification of a service cannot always be based solely on the diagnosis.  Some medical policies also include frequency and utilization guidelines that will require coordination with the ordering physician/practitioner who has knowledge of the patient’s medical history.  Remember, this same medical policy has also been issued to professional providers so they are aware of the guidelines. 

All claims for services associated with a medical policy are reviewed before the claim is finalized.  Sometimes medical records are requested to ensure that the services provided meet the criteria in the medical policy.  When this is the case, please obtain the needed information and return the letter along with a new claim to us.  These instructions also apply to claims denied for additional information when indicated as such on a remittance advice (RA).  Your remittance advice will reflect a M118 or M58 remark code. 

We respectfully ask that providers do not indicate "corrected claim" on a new claim being resubmitted because of a denial as outlined above. The only instance when it is appropriate to indicate "corrected claim" on a resubmission is when payment has already been made and the provider discovers the original claim was not filed correctly. Claims that come in marked "corrected claim" are routed through our customer service center for research, which may in turn delay claim adjudication.

Providers are encouraged to review our online medical policies (BCBSKS Medical Policies).  Whenever a medical policy is revised or a new policy published, BCBSKS sends out a Web notice (ListServ) to providers.  To sign up for ListServ, visit the Web at http://www.bcbsks.com/CustomerService/Providers/enews_institutional.htm

Questions or concerns regarding a medical policy should be discussed with your provider consultant.