Tag: Blue Cross Blue Shield (BCBS)
More on HCSC Acquisition of Cigna MA
Can this get anymore confusing?
🏢 What is HCSC?
Health Care Service Corporation (HCSC) is:
The largest customer-owned (non-investor-owned) health insurer in the U.S.
A licensee of the Blue Cross and Blue Shield Association (BCBSA).
It operates five Blue Cross Blue Shield health plans:
Blue Cross and Blue Shield of Illinois
Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of New Mexico
Blue Cross and Blue Shield of Oklahoma
Blue Cross and Blue Shield of Montana
đź”— What is the Relationship Between HCSC and BCBS?
BCBS is a national brand and association, not a single company. It licenses its brand to independent regional companies.
HCSC is one of those companies, and it owns and operates the BCBS plans in the five states listed above.
So, when someone has BCBS of Illinois, for example, their insurance is actually managed and provided by HCSC.
Acquisition Completed March 19, 2025.Â
It has been stated:
- Members will have the same plan, benefits, and network structure.
- No changes are expected for 2025.
- Members should not expect any changes in coverage of out-of-pocket cost.Â
- And the one thing we hope will change is, BCBS says we can still expect the same level of service.Â
Check Your BCBS Flu Test Claims
BCBSTX explained in correspondence with TMA’s Physician Payment Resource Center (PPRC) – which reached out for clarification earlier this month on the payer’s new flu testing policy – that some claims for certain labs, including those offering flu testing, were unintentionally denied due to a vendor error.
TMA’s Director of Physician Payment Services Carra Benson says physicians do not need to take action to receive payment. However, she recommends physicians review flu testing claims filed between Jan. 1 and Feb. 13 to ensure correct reprocessing.
Cigna Medicare Business Acquisition Completed
Well, it is final. As of today, March 19, 2025 Health Care Service Corporation
(HCSC) has acquired Cigna’s Medicare operations.
HCSC has acquired Cigna’s Medicare businesses, including Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D, and CareAllies.Â
It has been stated:
- Members will have the same plan, member ID, benefits, and network structure.
- No changes are expected for 2025
- You should not expect any changes in coverage levels or out-of-pocket cost.
- And the one we all hoped would change, BCBS says we can still expect the same level of service.
Aetna Reverses NPP Payment Reduction
By: Hannah Wisterman ~ 2/12/25
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On January 31st, InK reported Aetna was changing it’s policy on billing for Non-Physician Providers (NPP). As of February 10th Aetna has changed their stand. Please Read!
Aetna’s Feb. 10 reversal preserves NPPs’ ability to fully bill under a supervising physician’s name and National Provider Identifier (NPI) for services “incidental to” the physician’s diagnosis and treatment of an injury or illness. Services billed incident-to must be conducted in the same office suite where the physician is present and available to intervene if needed.Â
Having Trouble Locating BCBS 1st Qtr HCPCs?
POET has heard from Genesis our BCBS Network Management Consultant. 2024 HCPCs schedules are still in effect. The 1st quarter update will be effective March 1, 2025.
ALERT: BCBS Not All PPO in the Suitcase Cards Follow the Rule
SAY IT ISN’T SO!
Things to look for: But remember cards are so tricky these days, what applies to one, may not apply for another:
Is the “Texas Department of Insurance” acronym TDI on the card?  If a health insurance card does not have “TDI” on it, it is likely an ERISA plan, meaning it is a self-funded plan regulated by federal law and not by the Texas Department of Insurance (TDI) because the employer directly pays claims instead of relying on an insurance company; the absence of “TDI” indicates the plan is self-funded and therefore likely falls under ERISA regulations. (resource tdi.texas.gov)
Look for these phrases, usually on the back of the card:
“BCBS provides administrative services only and assumes no financial risk for claims.”
“JBS will utilize Anthem to handle member contract for Health plan administration”
“Anthem Blue Cross and Blue Shield provide administrative claims payment services only and does not assume any financial risk or obligation with respect to claims”
“BCBST provides administrative services only and assumes no financial risk for claims.”
2/11/25 Amended to add Cigna. Look for these terms on Cigna Commercial cards:
- Shared Administration (S)
- Benefits are not insured by Cigna or Affiliates
Scrutinize each member’s card on an individual patient basis. No rule is across the board.Â
You May Be Entitled to a Settlement from BCBS
The class action lawsuit, In re: Blue Cross Blue Shield Antitrust Litigation, addresses Provider Plaintiffs’ claim that the Settling Defendants violated antitrust laws by illegally dividing the United States into “Service Areas” and agreeing not to compete in those areas. Provider Plaintiffs also claim that the Settling Defendants fixed prices for services provided. The class action is pending in the United States District Court for the Northern District of Alabama, Southern Division. U.S. District Judge R. David Proctor is overseeing it. Both sides want to avoid the risk and cost of further litigation and have agreed to the Settlement. The Provider Plaintiffs and their attorneys think the Settlement is best for the Settlement Class.
This Settlement Class includes all Providers in the U.S. (except Excluded Providers FAQ 5, who are not part of the Settlement Class) who currently provide or provided healthcare services, equipment or supplies to any patient who was insured by, or was a Member of or a beneficiary of, any plan administered by any Settling Individual Blue Plan from July 24, 2008 to October 4, 2024 (“Settlement Class Period”). Class Members who submit a valid approved claim (“Authorized Claimants”) will receive a payment from the Net Settlement Fund if the Settlement is approved
To visit the official platform Portal for Settlement Class Members to submit claims for a share of the Net Settlement Fund and to get up-to-date information about the Settlement Program. Follow the link below.Â
BCBSTX no longer paying for Consults
Effective 11/18/2024
If you missed it, check out the article posted 9/4/2024
“BCBSTX to Require E/M Codes for Consultation Services”
BCBSTX to Require E/M Codes for Consultation Services
Starting Nov. 18, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology (CPT) codes 99242 – 99245 and 99252 – 99255.Â
Instead, the payer says physicians will need to report consultation services with an appropriate office outpatient or inpatient evaluation and management (E/M) code representing where the visit occurred and its level of complexity. Â
According to the health plan, consultation claims reported with CPT codes after Nov. 18 will be denied.Â
Updated 12/10/2024, to add BCBS website information
Evaluation and Management Coding – Professional Provider Services
Policy Number: CPCP024
Version 1.0
Enterprise Clinical Payment and Coding Policy Committee Approval Date:
August 7, 2024
Plan Effective Date: November 18, 2024
(Blue Cross and Blue Shield of Texas Only
Consultation(s) CPT Codes 99242-99245 ,99252-99255 Effective 11/18/2024, the plan will no longer reimburse for office/outpatient consultation codes (CPT codes 99242–99245) and inpatient consultation codes (CPT codes 99252–99255). Consultation services should be reported with an appropriate office/outpatient or inpatient E/M code representing the location where the visit occurred and the level of complexity of the visit performed, such as code ranges 99221-99223, 99304-99306, and 99202-99215.
Change HealthCare!
Looking for answers? So is POET. We are looking for work-arounds. Hopefully we will have some up before closing today.
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