provcomm.ibx.com
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144.42.99.18
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Submitted URL: http://provcomm.ibx.com/
Effective URL: https://provcomm.ibx.com//pnc-ibc/Pages/Home.aspx
Submission: On April 29 via manual from US — Scanned from DE
Effective URL: https://provcomm.ibx.com//pnc-ibc/Pages/Home.aspx
Submission: On April 29 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /pnc-ibc/Pages/Home.aspx
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var g_wsaQoSDataPoints = [];
var g_wsaRUMEnabled = false;
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var _fV4UI = true;
var _spPageContextInfo = {
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siteAbsoluteUrl: "https:\u002f\u002fprovcomm.ibx.com",
serverRequestPath: "\u002fpnc-ibc\u002fPages\u002fHome.aspx",
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currentLanguage: 1033,
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customMarkupInCalculatedFieldDisabled: true,
siteServerRelativeUrl: "\u002f",
allowSilverlightPrompt: 'True',
isSiteAdmin: false
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function CallServer_28364017(arg, context) {
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}
function _myLinksRibbonLoad2() {
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};
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function _myLinksRibbonLoad1() {
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}
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var L_Menu_SiteTheme = "null";
document.onreadystatechange = fnRemoveAllStatus;
function fnRemoveAllStatus() {
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if (!_spBodyOnLoadCalled) {
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SP.SOD.executeFunc(script, type, function() {});
}
var __SafeRunFunctionQueue = null;
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function __ProcessQueuedFunctions() {
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var ysObj = window.SP.YammerSwitch;
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ysObj.TargetYammerHostName = "www.yammer.com";
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var g_syncButtonUsePopup = true;
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function WebForm_OnSubmit() {
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<div class="noindex">You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.</div>
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<a id="linkTurnOffAnimation" data-accessibility-nocheck="true" href="#" class="ms-accessible ms-acc-button" onclick="ToggleAnimationStatus();return false;">
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<div id="TurnOnAnimation" style="display:none;" class="s4-notdlg noindex">
<a id="linkTurnOnAnimation" data-accessibility-nocheck="true" href="#" class="ms-accessible ms-acc-button" onclick="ToggleAnimationStatus();return false;">
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<div id="ms-hcTest">
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<div id="ms-designer-ribbon" style="display:none">
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<div id="suiteBarDelta" class="ms-dialogHidden ms-fullWidth noindex">
<div id="suiteMenuData" class="ms-hide">
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<div class="o365cs-nav-appItem">
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<div class="date" id="effDateA">March 25, 2024</div>
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<p><span>Independence Blue Cross launched a series of on-demand training sessions to help providers prepare for our transition to a new claims processing platform – a next generation solution that will help us
efficiently deliver new and innovative products and services. Now available, the fifth training session covers the following topics: Electronic Provider Payments (EPP) updates Taxonomy reminders Claims
submission tips</span></p>
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<div class="sub-card-content">We recently transitioned to PNC Bank's Claim Payments & Remittances (CPR) service, powered by ECHO Health, for medical claim payments and remittances and capitation payments.
As a result, you will start to see a new Explanation of Provider Payment (EPP) for claims processed on the new platform after January 1, 2024.</div>
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<h5 class="card-title-2">Options to receive ERA/835s during Change Healthcare service interruption</h5>
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<div class="date">March 15, 2024</div>
<div class="tags"><span class="p-1">Reimbursement</span></div>
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<div class="sub-card-content">As previously communicated, Independence Blue Cross confirmed that Change Healthcare, a clearinghouse used by some of our providers, is experiencing a network interruption
related to a cyber security issue. Until service with Change Healthcare is restored, we encourage you to change the clearinghouse used to receive your Electronic Remittance Advice (ERA) or 835 to another
clearinghouse. Waystar recently migrated to Smart Data Solutions, our new EDI Gateway vendor, and can be used as an alternate clearinghouse. Note: Enrollment for claims submission via Waystar is no longer
required. Other clearinghouse options may include Availity, Experian, or Trizetto. For additional questions on ERA/835 options, please email our EDI team at gateway.transition@ibx.com.</div>
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<li>Independence: 1-800-ASK-BLUE (1-800-275-2583)<br></li>
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<div class="sub-title" id="subTitleId306">Policies & Regulations</div>
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<div class="mian-title" id="mainTitleId306">Updates to evinacumab-dgnb (Evkeeza<sup>®</sup>)</div>
<div class="sub-section" id="subSectionId306">
<div class="date-tags" id="dateTagId306">
<div class="date d-flex align-items-center" id="dateTagContentId306">April 24, 2024<span class="tag-style">Medical Policy</span></div>
</div>
<div class="share-icon" id="iconsId306" proparticletitle="Updates to evinacumab-dgnb (Evkeeza®)" propurl="/pnc-ibc/news/Pages/Updates-to-evinacumab-dgnb-Evkeeza.aspx"><img
src="/pnc-ibc/SiteAssets/Assets/Icons/Actions.svg"></div>
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<div class="sub-contents" id="subContentID306">Independence Blue Cross is updating its policy on evinacumab-dgnb (Evkeeza<sup>®</sup>), effective May 27, 2024.The new version of the policy updates the
treated LDL-C levels from ≥ 70 mg/dL to ≥ 100 mg/dL, in accordance with the American College of Cardiology Guidelines.This updated policy also expands the coverage for pediatric individuals ages 5
– 11 with homozygous familial hypercholesterolemia (HoFH), in alignment with the U.S. Food and Drug Administration (FDA).For more information, please refer to the following updated policies in
Notification, which will be published and available via the Medical Policy Portal starting May 28, 2024:Commercial: #08.01.76c: evinacumab-dgnb (Evkeeza<sup>™</sup>)Medicare Advantage: #MA08.133c:
evinacumab-dgnb (Evkeeza<sup>™</sup>)To find the most updated version of any given policy, please refer to the Medical Policy Portal or simply navigate to the Commercial or Medicare Advantage policy
bulletins. </div>
<div class="read-more" id="readMoreId306">
<p class="text-end p-1" id="readMorePTagId306"><a href="/pnc-ibc/news/Pages/Updates-to-evinacumab-dgnb-Evkeeza.aspx" target="_blank">Read more</a><i class="fa-sharp fa-solid fa-chevron-right"></i></p>
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<div class="sub-title" id="subTitleId305">Claims & Billing</div>
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<div class="mian-title" id="mainTitleId305">Enhanced Claim Editor Program: Route of Administration Modifiers JA and JB</div>
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<div class="date d-flex align-items-center" id="dateTagContentId305">April 17, 2024<span class="tag-style">Submitting Claims</span></div>
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<div class="share-icon" id="iconsId305" proparticletitle="Enhanced Claim Editor Program: Route of Administration Modifiers JA and JB"
propurl="/pnc-ibc/news/Pages/Enhanced-Claim-Editor-Program-Route-of-Administration-Modifiers-JA-and-JB.aspx"><img src="/pnc-ibc/SiteAssets/Assets/Icons/Actions.svg"></div>
</div>
<div class="sub-contents" id="subContentID305">The Centers for Medicare & Medicaid Services (CMS) generally creates codes for drugs and biologics that represent the product itself without specifying a
route of administration in the code descriptor. This is done because there might be multiple routes of administration for the same product.For drugs that have only one HCPCS Level II (J or Q) code but
multiple routes of administration, providers should append one of the following modifiers to describe the given route of administration:JAAdministered intravenouslyJBAdministered
subcutaneously Claims for drugs with multiple routes of administration and only one HCPCS Level II (J or Q) code reported without either a JA or JB modifier will be denied.The Enhanced Claim Editor
Program supports our commitment to ensure compliance with reporting requirements and guidelines endorsed by national and regional industry sources. We continue to evaluate and review our claim payment
policies, industry standard sources, and specialty societies to identify additional claim edits and make changes where necessary.ResourcesFor further questions about the enhanced claim editing process,
review our Enhanced Claim Editor Program: Frequently asked questions.If you still have questions after reviewing these resources, please email claimeditquestions@ibx.com.</div>
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<div class="sub-title" id="subTitleId303">Policies & Regulations</div>
<div class="effective-date" id="effeDateMainId303">
<div class="date p-2" id="effeDateId303">Effective April 14</div>
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<div class="mian-title" id="mainTitleId303">Revision to Clinical Appropriateness Guidelines for High-Technology Radiology Services</div>
<div class="sub-section" id="subSectionId303">
<div class="date-tags" id="dateTagId303">
<div class="date d-flex align-items-center" id="dateTagContentId303">April 15, 2024<span class="tag-style">Medical Policy</span></div>
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<div class="share-icon" id="iconsId303" proparticletitle="Revision to Clinical Appropriateness Guidelines for High-Technology Radiology Services"
propurl="/pnc-ibc/news/Pages/Revision-to-Clinical-Appropriateness-Guidelines-for-High-Technology-Radiology-Services.aspx"><img src="/pnc-ibc/SiteAssets/Assets/Icons/Actions.svg"></div>
</div>
<div class="sub-contents" id="subContentID303">Effective April 14, 2024, Carelon Medical Benefits Management<sup>®</sup> has revised its Clinical Appropriateness Guidelines for Advanced Imaging for
Radiology and Cardiology in the areas of Imaging of the Heart, Abdomen and Pelvis, Brain, Chest, Head and Neck, and Oncologic Imaging for Independence Blue Cross and Independence Administrators. This
revision applies to Commercial and Medicare Advantage members.For a detailed summary of changes, see the specific guidelines available on the Carelon Medical Benefits Management site for Radiology and
Cardiology.As Medical Policy updates occur over time, outdated policy links may expire. To always view the most updated version of this policy, please visit our Commercial or Medicare Advantage Medical
Policy Portal to find the following:Commercial: 09.00.46aq: High-Technology Radiology Services (Independence)Medicare Advantage: MA09.002ab: High-Technology Radiology ServicesYou can also use
the Medical and Claim Payment Policy Portal by searching for the associated policy number, title, or key word (e.g., 09.00.46, High-Technology Radiology Services, High-Technology, etc.).</div>
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<div class="sub-title" id="subTitleId304">Policies & Regulations</div>
<div class="effective-date" id="effeDateMainId304">
<div class="date p-2" id="effeDateId304">Effective April 14</div>
</div>
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<div class="mian-title" id="mainTitleId304">Musculoskeletal Services: Revision to Clinical Appropriateness Guidelines</div>
<div class="sub-section" id="subSectionId304">
<div class="date-tags" id="dateTagId304">
<div class="date d-flex align-items-center" id="dateTagContentId304">April 15, 2024<span class="tag-style">Medical Policy</span></div>
</div>
<div class="share-icon" id="iconsId304" proparticletitle="Musculoskeletal Services: Revision to Clinical Appropriateness Guidelines"
propurl="/pnc-ibc/news/Pages/Musculoskeletal-Services-Revision-to-Clinical-Appropriateness-Guidelines.aspx"><img src="/pnc-ibc/SiteAssets/Assets/Icons/Actions.svg"></div>
</div>
<div class="sub-contents" id="subContentID304">Effective April 14, 2024, Carelon Medical Benefits Management<sup>®</sup> has revised its Clinical Appropriateness Guidelines for
Musculoskeletal-Interventional Pain Management and Sacroiliac Joint Fusion for Independence Blue Cross and Independence Administrators. This revision applies to Commercial and Medicare Advantage
members.For a detailed summary of changes, see the specific Musculoskeletal Guidelines available on the Carelon Medical Benefits Management site.As Medical Policy updates occur over time, outdated policy
links may expire. To always view the most updated version of this policy, please visit our Commercial or Medicare Advantage Medical Policy Portal to find the following:Commercial: 00.01.66l:
Musculoskeletal Services (Independence)Medicare Advantage: MA00.047l: Musculoskeletal ServicesYou can also use the Medical and Claim Payment Policy Portal by searching for the associated policy
number, title, or key word (e.g., 00.001.66, Musculoskeletal Services, Musculoskeletal, etc.).</div>
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<a href="/pnc-ibc/news/Pages/Musculoskeletal-Services-Revision-to-Clinical-Appropriateness-Guidelines.aspx" target="_blank">Read more</a><i class="fa-sharp fa-solid fa-chevron-right"></i></p>
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<div class="sub-title" id="subTitleId302">Programs</div>
</div>
<div class="mian-title" id="mainTitleId302">Fighting against Fraud, Waste, and Abuse</div>
<div class="sub-section" id="subSectionId302">
<div class="date-tags" id="dateTagId302">
<div class="date d-flex align-items-center" id="dateTagContentId302">April 12, 2024<span class="tag-style">Provider Programs</span></div>
</div>
<div class="share-icon" id="iconsId302" proparticletitle="Fighting against Fraud, Waste, and Abuse" propurl="/pnc-ibc/news/Pages/Fighting-against-Fraud-Waste-and-Abuse.aspx"><img
src="/pnc-ibc/SiteAssets/Assets/Icons/Actions.svg"></div>
</div>
<div class="sub-contents" id="subContentID302">The National Health Care Anti-Fraud Association estimates that financial losses due to health care fraud are in the tens of billions of dollars each year.
Independence Blue Cross's Corporate and Financial Investigations Department (CFID) continues to seek contemporary ways to fight against insurance fraud, waste, and abuse (FWA). CFID detects,
investigates, reports, and prevents potential FWA with the help of confidential information received from its providers, members, employees, and the public.The confidential information received supports
our analysts, auditors, and investigators in examining allegations of FWA. As a provider, you can help fight against health care fraud by staying vigilant to suspicious activity, such as the
following:Fake surgeries and treatments: Inflating bills for unnecessary procedures.Phantom tests: Billing for tests never performed.Kickback deals: Doctors getting paid to refer patients to specific
services.Billing ghosts: Services never rendered, or inflated claims.Upcoding and unbundling: Billing for more expensive procedures or separating simple procedures into multiple charges.Misleading
bills: Claiming non-covered treatments as covered.Copay cover-up: Waiving patient costs and charging the insurer.Prescription scams: Stealing or forging prescriptions.Telemarketers: Be cautious of
unsolicited telemarketers and recruiters.Preventing fraudSimple ways your patients can prevent fraud and abuse include:Review your Explanation of Benefits (EOB): Check for accuracy.Guard your insurance
card: Treat it like a credit card.Count your pills: Verify your prescriptions.Research your providers: Check licenses and reviews.Report suspicious activity: Please don't hesitate!Reporting fraudIf you
suspect fraud, please refer to these confidential reporting options that do not require any identifying information:Online: Fraud & Abuse Tip Referral Form Phone: 1-866-282-2707 (TTY:
888-789-0429) Mail: Independence Blue Cross, CFID, 1901 Market Street, 42nd Floor, Philadelphia, PA 19103Visit our Anti-fraud and Financial Investigations section for more information.</div>
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You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Turn on more accessible mode Turn off more accessible mode Skip Ribbon Commands Skip to main content Turn off Animations Turn on Animations Newsfeed OneDrive Sites SharePointSites ▸ Share Help srv-pnc-exaccess About MeSign Out srv-pnc-exaccess Share Follow -------------------------------------------------------------------------------- Provider News Center * Home * Policies & Regulations * Products * Claims & Billing * Programs * Resources Homepage Programs Fifth platform training session March 25, 2024 Provider Programs Independence Blue Cross launched a series of on-demand training sessions to help providers prepare for our transition to a new claims processing platform – a next generation solution that will help us efficiently deliver new and innovative products and services. Now available, the fifth training session covers the following topics: Electronic Provider Payments (EPP) updates Taxonomy reminders Claims submission tips Read more CLAIMS & BILLING NEW! EXPLANATION OF PROVIDER PAYMENT March 7, 2024 Reimbursement We recently transitioned to PNC Bank's Claim Payments & Remittances (CPR) service, powered by ECHO Health, for medical claim payments and remittances and capitation payments. As a result, you will start to see a new Explanation of Provider Payment (EPP) for claims processed on the new platform after January 1, 2024. Read more CLAIMS & BILLING OPTIONS TO RECEIVE ERA/835S DURING CHANGE HEALTHCARE SERVICE INTERRUPTION March 15, 2024 Reimbursement As previously communicated, Independence Blue Cross confirmed that Change Healthcare, a clearinghouse used by some of our providers, is experiencing a network interruption related to a cyber security issue. Until service with Change Healthcare is restored, we encourage you to change the clearinghouse used to receive your Electronic Remittance Advice (ERA) or 835 to another clearinghouse. Waystar recently migrated to Smart Data Solutions, our new EDI Gateway vendor, and can be used as an alternate clearinghouse. Note: Enrollment for claims submission via Waystar is no longer required. Other clearinghouse options may include Availity, Experian, or Trizetto. For additional questions on ERA/835 options, please email our EDI team at gateway.transition@ibx.com. Read more PLATFORM TRANSITION Stay informed about our next generation platform. PEAR PORTAL Use single sign-on to reach our provider portal. COVID-19 CENTER Stay up to date on COVID-19 news and policies. PROVIDER NEWS CENTER ARCHIVE Look here for previously published articles. CONTACT US PROVIDER SERVICES: * Independence: 1-800-ASK-BLUE (1-800-275-2583) * Independence Administrators: 1-888-356-7899 PEAR PORTAL SUPPORT:1-833-444-PEAR (1-833-444-7327) PROVIDER NETWORK SERVICES (PNS) CONTACTS: * Independence: Provider Network Services (PNS) contact tool * Independence Administrators: provrelations@ibx.com OTHER CONTACT INFORMATION AdministrationBillingClinical Care Select Your Job Role * Administration * Billing * Clinical Care Filter to find the news that is relevant to your role. TOPIC * Claims & Billing Policies & Regulations Products Programs PUBLISH DATE * Today Last 7 Days Last 30 Days Custom Range... TAG * -------------------------------------------------------------------------------- Authorizations BlueCard® Commercial Contracting Health Equity Medical Policy Medicare Medicare Advantage Member Programs Pharmacy Provider Programs Quality Management Regulatory Reimbursement Submitting Claims Vendors TYPE * Articles Policies & Regulations Updates to evinacumab-dgnb (Evkeeza®) April 24, 2024Medical Policy Independence Blue Cross is updating its policy on evinacumab-dgnb (Evkeeza®), effective May 27, 2024.The new version of the policy updates the treated LDL-C levels from ≥ 70 mg/dL to ≥ 100 mg/dL, in accordance with the American College of Cardiology Guidelines.This updated policy also expands the coverage for pediatric individuals ages 5 – 11 with homozygous familial hypercholesterolemia (HoFH), in alignment with the U.S. Food and Drug Administration (FDA).For more information, please refer to the following updated policies in Notification, which will be published and available via the Medical Policy Portal starting May 28, 2024:Commercial: #08.01.76c: evinacumab-dgnb (Evkeeza™)Medicare Advantage: #MA08.133c: evinacumab-dgnb (Evkeeza™)To find the most updated version of any given policy, please refer to the Medical Policy Portal or simply navigate to the Commercial or Medicare Advantage policy bulletins. Read more Claims & Billing Enhanced Claim Editor Program: Route of Administration Modifiers JA and JB April 17, 2024Submitting Claims The Centers for Medicare & Medicaid Services (CMS) generally creates codes for drugs and biologics that represent the product itself without specifying a route of administration in the code descriptor. This is done because there might be multiple routes of administration for the same product.For drugs that have only one HCPCS Level II (J or Q) code but multiple routes of administration, providers should append one of the following modifiers to describe the given route of administration:JAAdministered intravenouslyJBAdministered subcutaneously Claims for drugs with multiple routes of administration and only one HCPCS Level II (J or Q) code reported without either a JA or JB modifier will be denied.The Enhanced Claim Editor Program supports our commitment to ensure compliance with reporting requirements and guidelines endorsed by national and regional industry sources. We continue to evaluate and review our claim payment policies, industry standard sources, and specialty societies to identify additional claim edits and make changes where necessary.ResourcesFor further questions about the enhanced claim editing process, review our Enhanced Claim Editor Program: Frequently asked questions.If you still have questions after reviewing these resources, please email claimeditquestions@ibx.com. Read more Policies & Regulations Effective April 14 Revision to Clinical Appropriateness Guidelines for High-Technology Radiology Services April 15, 2024Medical Policy Effective April 14, 2024, Carelon Medical Benefits Management® has revised its Clinical Appropriateness Guidelines for Advanced Imaging for Radiology and Cardiology in the areas of Imaging of the Heart, Abdomen and Pelvis, Brain, Chest, Head and Neck, and Oncologic Imaging for Independence Blue Cross and Independence Administrators. This revision applies to Commercial and Medicare Advantage members.For a detailed summary of changes, see the specific guidelines available on the Carelon Medical Benefits Management site for Radiology and Cardiology.As Medical Policy updates occur over time, outdated policy links may expire. To always view the most updated version of this policy, please visit our Commercial or Medicare Advantage Medical Policy Portal to find the following:Commercial: 09.00.46aq: High-Technology Radiology Services (Independence)Medicare Advantage: MA09.002ab: High-Technology Radiology ServicesYou can also use the Medical and Claim Payment Policy Portal by searching for the associated policy number, title, or key word (e.g., 09.00.46, High-Technology Radiology Services, High-Technology, etc.). Read more Policies & Regulations Effective April 14 Musculoskeletal Services: Revision to Clinical Appropriateness Guidelines April 15, 2024Medical Policy Effective April 14, 2024, Carelon Medical Benefits Management® has revised its Clinical Appropriateness Guidelines for Musculoskeletal-Interventional Pain Management and Sacroiliac Joint Fusion for Independence Blue Cross and Independence Administrators. This revision applies to Commercial and Medicare Advantage members.For a detailed summary of changes, see the specific Musculoskeletal Guidelines available on the Carelon Medical Benefits Management site.As Medical Policy updates occur over tim e, outdated policy links may expire. To always view the most updated version of this policy, please visit our Commercial or Medicare Advantage Medical Policy Portal to find the following:Commercial: 00.01.66l: Musculoskeletal Services (Independence)Medicare Advantage: MA00.047l: Musculoskeletal ServicesYou can also use the Medical and Claim Payment Policy Portal by searching for the associated policy number, title, or key word (e.g., 00.001.66, Musculoskeletal Services, Musculoskeletal, etc.). Read more Programs Fighting against Fraud, Waste, and Abuse April 12, 2024Provider Programs The National Health Care Anti-Fraud Association estimates that financial losses due to health care fraud are in the tens of billions of dollars each year. Independence Blue Cross's Corporate and Financial Investigations Department (CFID) continues to seek contemporary ways to fight against insurance fraud, waste, and abuse (FWA). CFID detects, investigates, reports, and prevents potential FWA with the help of confidential information received from its providers, members, employees, and the public.The confidential information received supports our analysts, auditors, and investigators in examining allegations of FWA. As a provider, you can help fight against health care fraud by staying vigilant to suspicious activity, such as the following:Fake surgeries and treatments: Inflating bills for unnecessary procedures.Phantom tests: Billing for tests never performed.Kickback deals: Doctors getting paid to refer patients to specific services.Billing ghosts: Services never rendered, or inflated claims.Upcoding and unbundling: Billing for more expensive procedures or separating simple procedures into multiple charges.Misleading bills: Claiming non-covered treatments as covered.Copay cover-up: Waiving patient costs and charging the insurer.Prescription scams: Stealing or forging prescriptions.Telemarketers: Be cautious of unsolicited telemarketers and recruiters.Preventing fraudSimple ways your patients can prevent fraud and abuse include:Review your Explanation of Benefits (EOB): Check for accuracy.Guard your insurance card: Treat it like a credit card.Count your pills: Verify your prescriptions.Research your providers: Check licenses and reviews.Report suspicious activity: Please don't hesitate!Reporting fraudIf you suspect fraud, please refer to these confidential reporting options that do not require any identifying information:Online: Fraud & Abuse Tip Referral Form Phone: 1-866-282-2707 (TTY: 888-789-0429) Mail: Independence Blue Cross, CFID, 1901 Market Street, 42nd Floor, Philadelphia, PA 19103Visit our Anti-fraud and Financial Investigations section for more information. 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