A newsletter for the Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania and southeastern Pennsylvania
Issue 10, October 2023
Reimbursement Updates, including Changes to RP-072Highmark regularly issues new or updated reimbursement policies. Keep an eye on this newsletter and the Provider Resource Center (PRC) homepage for announcements regarding upcoming policy changes. As specific policy changes go into effect, the updated policies can be found on the Reimbursement Policy page of the PRC.
RP-072 Injection and Infusion Services
Effective January 1, 2024, Highmark will be applying a system enhancement to identify when chemotherapy administration codes are billed and enforce the direction currently defined on Reimbursement Policy (RP)-072. For providers, this enhancement will reduce administrative costs associated with claim audits and adjustments by supporting the correct adjudication of claims before the finalization of initial claim processing.
To view the current version of RP-072, go to the Provider Resource Center, choose CLAIMS, PAYMENT & REIMBURSEMENT from the left menu and then Reimbursement Policy.
RP-064 Government Supplied Vaccinations and Antibody Treatments
Policy was updated with new and deleted vaccine codes.
RP-007 Multiple Procedure Payment Reduction for Certain Diagnostic Imaging Procedures
Policy was updated with new and deleted imaging codes.
RP-049 Merit-based Incentive Payment System (MIPS) for Out of Network Providers
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-055 Nominal Charges
This policy was made applicable to professional (1500) claims.
RP-060 Genetic Testing Ordering Requirements
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-069 DME Maintenance, Repair and Replacement
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-071 Incremental Nursing
This policy was reviewed as part of our standard review process. No changes in direction were made.
RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US
This policy will be made applicable to Medicare Advantage. Additional direction will be added for modifiers UN, UP, UQ, UR, and US when submitted with code R0075 (a transportation service code). These modifiers are also required to be included on all related claims, and the Commercial section will be updated with direction to reflect this requirement.
RP-064 Government Supplied Vaccinations and Antibody Treatments
Policy will be updated to delete vaccine codes.
RP-072 Injection and Infusion Services
Effective January 1, 2024, Highmark will be applying a system enhancement to identify when chemotherapy administration codes are billed and enforce the direction currently defined on Reimbursement Policy (RP)-072. For providers, this enhancement will reduce administrative costs associated with claim audits and adjustments by supporting the correct adjudication of claims before the finalization of initial claim processing.
RP-037 Emergency Evaluation and Management Coding Guidelines
Outpatient surgery will be removed from the exclusion criteria.
