The following Pharmacy Medical Policy programs have been updated June 1, 2023:

Effective July 1, 2023:

• Healthcare Administered Multiple Sclerosis
• Antifungals (formerly Antifungal Agents [Brexafemme/Cresemba/Noxafil/Vfend/Vivjoa])
• Parathyroid Hormone Analog Osteoporosis
• Rituximab
• Tezspire
• Urea Cycle Disorders
• Biologic Immunomodulators
• Vijoice
• Fintepla
• Continuous Glucose Monitoring Systems (CGM)
• Acute Migraine Agents
• CGRP
• HCPA CGRP
• Enjaymo

The following policies are archiving due to being retired:

Effective May 1, 2023:

• Gabapentin ER  

Effective June 1, 2023:

• Lucemyra 

If you have any questions regarding this newsletter, please contact your BCBSKS provider representative/consultant.

Institutional Providers
Professional Providers

Maintaining accurate provider information is critically important to ensure consumers have timely access to care. Updated information helps Blue Cross and Blue Shield of Kansas (BCBSKS) maintain accurate provider directories and ensure providers are easily accessible by our members.

All providers need to review and attest to the business information and provider information every 90 days.

Failure to attest as required by the Consolidated Appropriations Act (CAA) will remove your facility from the BCBSKS provider directory. Facilities that are not compliant will be suppressed beginning June 2, 2022.

Please have your Billing Office Manager log in to Blue Access (through Availity), and review/update your provider information. The steps below will direct you to the Provide Information Form.

Availity>Payer Spaces>Blue Cross Blue Shield of Kansas>BCBSKS Provider Secure Section (Blue Access)>Select your Facility NPI from the drop-down box>Services>Provider Information

Please note, it is only necessary for one person per facility to review the information. The form will need to be submitted regardless of whether changes are needed for your facility or not.

In the case the information we have on file is up to date and accurate, you will select the radio button at the bottom of the form that states, "I have reviewed and agree that the information above (without changes) is accurate" and submit the form.

To be certain patients have access to all contracting providers in our network, we will remind you periodically to check our online Provider Directory to confirm that your facility's information is accurate. Any future changes that may be necessary must be communicated to BCBSKS as soon as possible through the above listed process.

If you have any further questions or would like further assistance, please contact your BCBSKS Institutional Provider Consultant.

We are excited to visit a city near you!  

To sign up for Blue's Tour, please visit our 2023 Training and Workshop Schedule.  Space is limited, so sign up today!  We look forward to seeing you!

If you have any questions regarding the workshop, please contact the Education Consultant, Amanda Mellies. 

Blue Cross and Blue Shield of Kansas (BCBSKS) has published the following updated medical policies on the BCBSKS Website. Click on a link to view the details of each policy.

Published 05/23/23:

• Artificial Intervertebral Disc: Cervical Spine
• Artificial Intervertebral Disc: Lumbar Spine
• Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
• Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
• Deep Brain Stimulation
• Dry Needling of Myofascial Trigger Points
• Electrical Bone Growth Stimulation of the Appendicular Skeleton
• Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
• Interspinous and Interlaminar Stabilization / Distraction Devices (Spacers)
• Interspinous Fixation (Fusion) Devices
• Interventions for Progressive Scoliosis
• Intra-Articular Hyaluronan Injections for Osteoarthritis
• Meniscal Allografts and Other Meniscus Implants
• Orthopedic Applications of Platelet-Rich Plasma
• Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation
• Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, Biacuplasty and Intraosseous Basivertebral Nerve Ablation
• Percutaneous Vertebroplasty and Sacroplasty
• Sacral Nerve Neuromodulation / Stimulation
• Spinal Cord and Dorsal Root Ganglion Stimulation
• Surgical Treatment of Femoroacetabular Impingement

If you have questions regarding this publication, please contact your BCBSKS provider consultant/representative.

Institutional Providers
Professional Providers  

Blue Cross and Blue Shield of Kansas (BCBSKS) will be closed Monday, May 29, 2023 in observance of the Memorial Day holiday.

On Friday, May 26, 2023, week claims will be released. EFT payments will be sent Tuesday, May 30, 2023 and settle into provider accounts Thursday, June 1, 2023.The check payments will be mailed on Tuesday, May 30, 2023.

For more information, please contact your BCBSKS provider consultant/representative.

Institutional Providers
Professional Providers

On May 22, Availity is enhancing their eligibility and benefits display. This is a streamlined layout which reduces administrative effort and helps you find the data you need more quickly. Take a look at the Availity demo, created for all Availity partners, on the upcoming changes here.

Once logged in, under News and Announcements you will be able to find the article Availity posted that links to the demo.

If you have questions regarding this publication, please contact your BCBSKS provider consultant/representative.

Institutional Providers
Professional Providers  

Effective January 1, 2023, refractions for Blue Cross and Blue Shield of Kansas (BCBSKS) Blue Medicare Advantage (MA) members are covered when submitted with an exam to BCBSKS. Recently, it was discovered claims for the refraction service were inappropriately denying as non-covered when submitted. Impacted claims are being reprocessed.

As a Medicare Advantage plan, Blue MA is able to provide coverage beyond that of original Medicare, with the determination of refractive state, one of the latest expanded benefits. Providers should be sure to include the line item and procedure code for the refraction when submitting Blue MA claims to BCBSKS. EyeMed providers should continue to submit claims for routine eye exams and hardware to EyeMed.

For additional information on benefits, contact Blue MA Provider Services at the number on the member identification card, utilize Availity, or visit https://www.bcbsks.com/providers/medicare-advantage.

If you have any questions regarding this publication, please contact your BCBSKS MA provider representative.

The upcoming qualifying period ends May 31st for the every 90 day attestations confirming accurate provider data on file at Blue Cross and Blue Shield of Kansas (BCBSKS) through the Provider Portal. To access the Provider Portal, sign in through Availity.com, and select BCBSKS under payer spaces. 

Attesting to your provider demographics timely will ensure your QBRP incentive remains effective. This information is used in provider directories, network adequacy reporting, and other down-line operations within the health plan, adding to the importance of the data remaining current.

Keeping your provider contact information current is crucial for our members/your patients. A quick tutorial for attesting to data is available on the Education and Workshops page under Web-Based Education. 

Please contact your Professional Relations representative with any questions pertaining to the provider attestation QBRP. 

Professional Providers