October 2011
Welcome to The Connection Online
This publication contains important information, including updates to policies and procedures, for physicians, dentists, other health care and dental professionals, facilities and their staff.
If you haven't already, please subscribe to receive email notifications when new editions are available.
Learn about ICD-10 and available resources
On October 1, 2013, medical coding in U.S. health care settings will change from International Classification of Disease, Ninth Revision (ICD-9) to International Classification of Disease, Tenth Revision (ICD-10). This change will require major business and system changes throughout the health care industry.
Average wholesale price (AWP) primary source change as of September 28
First DataBank, our primary source for obtaining average wholesale price (AWP) for medications, recently discontinued publication of the Blue Book Average Wholesale Price (BBAWP). As of September 28, all National Drug Code (NDC) records containing AWP price values were removed from BBAWP and AWP pricing is no longer available from First DataBank.
We, therefore, began using Medispan as our primary source for AWP beginning September 28. This change should not impact our pricing of medical drug claims.
News and Updates
- View all of our recent updates in the What's New section of our website.
Administrative and Billing updates
- Administrative Manual updates
- Clinical practice guidelines updated
- Electronic Data Interchange (EDI) news and updates
- HIPAA 5010 address requirements
- Organizational credentialing reminder
- Pre-authorization lists revised
- Submit claims attachments electronically
- Taxonomy code requirement effective in January
Dental
Medicare
Products and Programs
Policies
Changes to our medical policies are listed below. Learn how policies are reviewed. Our Coding Toolkit includes codes that require clinical information (updated monthly), a complete list of code groupings and our Correct Code Editor (updated quarterly).
New clinical editing software to launch first quarter of 2012
Medical
Reimbursement
Medication
Learn how obsolete medication codes are reviewed on a quarterly basis.
Summaries of past changes and detailed policies are available in our Medication Policy Manual at http://blue.regence.com/policy/medication/
View our group and Individual products Preferred Medication List/Formulary.
Search the Asuris TruAdvantage + Rx and Medicare Part D formulary.