1. Highmark Blue Cross Blue Shield West Virginia Joyce Landers,Director Provider Relations

2. Autism Spectrum Disorder
As announced in the October 2011 issue of Provider News, the West Virginia Legislature passed a bill mandating coverage for diagnosis and treatment of Autism Spectrum Disorder (ASD) in children. Highmark Blue Cross Blue Shield West Virginia insured group policies issued or renewed on or after Jan. 1, 2012, will include coverage for diagnosis and treatment of ASD in children ages 0 months to 18 years. Coverage will include medically necessary treatments ordered or prescribed by a certified behavior analyst for any child diagnosed with ASD. In accordance with the legislation, Highmark West Virginia may require documentation of a treatment plan developed by a certified behavior analyst that incorporates comprehensive evaluations or re-evaluations of the child that can be reviewed upon request by Highmark West Virginia every six months, along with semi-annual progress reports.

3. Highmark Blue Cross Blue Shield West Virginia Announces A Limited Extension For Acceptance Of Version Electronic Transactions
The HIPAA mandate to use Version for all electronic claim, inquiry and related transactions becomes effective Jan. 1, Many providers and trading partners have successfully made the transition to the format and have assured themselves of no interruptions in claims processing and payment due to the use of non-compliant transactions. These business partners can now turn their attention to the complex implementation of ICD-10 for claims coding, as well as to other health care reform initiatives. However, there are a number of other providers and
trading partners who have not been as successful in their migration efforts. As announced in a Special eBulletin posted online Dec. 2, 2011, for these business partners, Highmark West Virginia, in alignment with CMS’ direction, will continue to accept Version transactions for 90 days past the Version compliance date of Jan. 1, 2012.

4. Radiation Therapy Authorization Program to Take Effect Jan. 1, 2012
As announced in the October 2011 issue of Provider News and in hospital and professional Special Bulletins dated Aug. 1, 2011, in an effort to help ensure that the radiation
therapy services provided to our members are consistent with nationally recognized clinical guidelines, Highmark West Virginia has contracted with CareCore National, LLC to
provide medical necessity review and authorization where applicable for select radiation therapy services, effective with dates of service of Jan. 1, 2012, and beyond. A follow-up Special Bulletin dated Dec. 1, 2011, recently sent to Highmark West Virginia network oncology and urology providers included additional information regarding the Radiation Therapy Authorization Program which takes effect Jan. 1, 2012.
The Special Bulletin included:
A list of products included in the program
• Step-by-step instructions for submitting authorization requests via NaviNet • Information about registering treatment plans prior to
Jan , for members who are currently in treatment
• A frequently asked questions and answers document

5. Watch for New Member ID Cards
As part of our official name change to Highmark Blue Cross
Blue Shield West Virginia, all member ID cards are being
converted to include the new name and logo. The revised ID
cards were recently distributed to members. An example of
the new ID card is shown at right. Providers are reminded to
always check the member’s ID card as well as the member’s
benefits via the Eligibility and Benefits function on NaviNet
prior to performing services.

6. Attention Anesthesiologists:
Highmark Blue Cross Blue Shield West Virginia applies anesthesia base units to procedure codes to determine reimbursement. Currently, Highmark West Virginia obtains these base units from the American Society of Anesthesiologists (ASA). The Centers for Medicare & Medicaid Services (CMS) also publishes anesthesia base units on its website.
For the most part, CMS anesthesia base units are the same as the ASA’s; however, for certain anesthesia procedure codes, the CMS base unit’s value is different. Beginning April 2, 2012, Highmark West Virginia will begin to use CMS as the sole source for anesthesia base units rather than the ASA for all Highmark West Virginia business, including HHIC Medicare Advantage PPO.

7. Use Appropriate NAIC Codes on Electronic Claims for HHIC FreedomBlue PPO Members to Avoid Denials
Plan
Alpha Prefix
Plan Code
NAIC Code
Highmark BCBS
HKS
363
54828
Highmark BS
HKR
378
HHIC FreedomBlue PPO
HKP, HQM
377
71768
Highmark BCBS Freedom PPO
FEM
Highmark BS Freedom Blue PPO
FER

8. * USE OF NAVINET AUTOMATED CARE MANAGEMENT REQUIRED FOR SUBMISSION OF ALL SCHEDULED INPATIENT AUTHORIZATION REQUESTS, EFFECTIVE APRIL 1, 2012 *
Effective April 1, 2012, Highmark West Virginia and Highmark Health Insurance Company (HHIC) will require all acute-care hospitals and critical access hospitals to submit their authorization requests for all scheduled inpatient admissions, including acute-to-acute transfer requests, through the NaviNet Automated Care Management (ACM) process.

9. Electronic Funds Transfer Registration Process Enhanced through NaviNet
On Feb. 6, 2012, Highmark Blue Cross Blue Shield West Virginia made a change to the Electronic Funds Transfer (EFT) Registration process to make it more efficient for provider offices. This change impacts the functions of the NaviNet Security office and the EFT Responsible Party.
Every provider that is NaviNet-enabled with Highmark West Virginia designates someone in their office as their NaviNet Security Officer. The Security Officer creates NaviNet Users and resets passwords as well as controls access to specific transactions.
Prior to the enhancement to the process, Highmark West Virginia providers did not have self- service access to register their banking information.
Highmark West Virginia has streamlined this process to allow the EFT Attestation and Registration button to be enabled for the Highmark West Virginia NaviNet offices. The NaviNet Security Officer can now enable/disable the EFT transaction permission for the office. The EFT Responsible party will be able to attest, electronically via NaviNet, to their position as the Responsible Party within the office. Separate paperwork is not required to receive the button or change banking information. The EFT Responsible Party will select only those providers/facilities for which they are the Responsible Party.
IMPORTANT: There are no changes to your current banking information. You will only need to electronically attest when you need to make a change to an existing account or register a new provider.