Short Takes: Legacy Claims Update, New Preventive Vaccines, & Outpatient Speech Therapy

CDC Adds Meningitis and Monkeypox Vaccines to 2024 Preventive Schedule

The Centers for Disease Control and Prevention (CDC) recently approved new vaccines for meningitis and monkeypox (now called mpox) for the 2024 Preventive Schedule effective Jan. 1, 2024. For procedure codes and more information, click here.

Acute Care Facilities: Itemized Bills Required for Local and Host Claims Starting at $50,000

Providers will be required to submit itemized bills for high-dollar, inpatient care (costing $50,000 or more) at acute care facilities, effective Feb. 6, 2024, for both local and host (out of area) claims. This new requirement — the previous threshold was $100,000 — is part of an initiative by Highmark to reduce billing and/or payment errors on high-dollar claims that occur both in-network (IN) and out-of-network (OON). For more information, click here.

Legacy Claims: Processing Changes for Medicare Crossover and ASK Claims

On Jan. 1, 2023, the final group of HealthNow members was migrated to the Highmark Blue Shield (BS) system. Over the past 12 months, Highmark BS has worked to efficiently process legacy claims — claims for dates of service that occurred prior to January 1, 2023.

In 2024, processing changes will occur to the following types of legacy claims:

  • Medicare Crossover
  • Administrative Services of Kansas (ASK)

To read more, click here.

Utilization Management of Outpatient Speech Therapy Moving to Helion Arc

Effective Feb. 1, 2024, Highmark is moving utilization management (UM) of outpatient speech therapy to Helion Arc. This change will result in faster approvals for prior authorization requests, submitted electronically, for appropriate services. To learn more, click here.

All Dental Claims Moving to United Concordia Effective March 18, 2024

Effective March 18, 2024, all dental claims — both electronic and paper — for Highmark Blue Cross Blue Shield (BCBS) and Highmark Blue Shield (BS) members must be submitted to United Concordia (UCD). Administrative Services of Kansas (ASK) will no longer accept electronically submitted dental claims (837D) effective March 18, 2024. To read the Special Bulletin, click here.