New Year Reminders
Happy 2023 from CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”). We wanted to take this opportunity to revisit some important information sent in December 2022 and be sure you were aware of a few recent updates including our new standard approved Ambulatory Surgery Center (ASC) codes.
2023 Standard Approved Ambulatory Service Center Codes Posted
CareFirst has released the 2023 standard approved codes eligible for payment in an ambulatory service center (ASC) setting for January 1, 2023, and January 15, 2023. The January 1 list is inclusive of only the changes related to new and deleted services for 2023. The January 15 list includes additional updates that were included in a letter to providers related to fee schedule changes. These lists are available under the Medical heading here.
Annual Medical Record Retrieval Requests in Progress
Each year, CareFirst is required by the Centers for Medicare and Medicaid Services (CMS) to participate in medical record retrieval requests that provide data to support their population health programs. On December 16, we sent a communication that outlined our current and future chart retrieval campaigns along with the steps to take if you receive a letter requesting records from one of our trusted vendors.
Each retrieval effort only applies to a subset of our provider networks and member population. Most practices could be involved in one to two throughout the year; very few would be involved in all efforts. Please note, if you are not contacted, you do not need to take any action.
Chart retrieval vendors will be reaching out on behalf of CareFirst to follow up on outstanding requests that were not completed by December 2022. These requests will include the specific member charts needed, and all the chart components required.
Vendors will provide several options to deliver the charts (e.g., secure fax, drop box, EMR access, scheduling a staff member to come on site to retrieve the charts). Please work with the vendor to arrange the best delivery method for your practice. If you utilize a central copy service vendor (like CIOX), please follow up and inform the chart retrieval vendors once the request is received.
For questions about any medical record request, please contact the vendor directly.
Reminder of Changes for Maryland Facilities: Utilization Management and Review Process
Effective January 1, 2023, Utilization Management (UM) will expect all Maryland Medical/Surgical hospitals to only include one day in their inpatient emergency admission requests for all Commercial and Federal Employee Program (FEP) members. The UM team will conduct concurrent reviews earlier to ensure timely care coordination and member engagement. Admissions and continued stay reviews should be based on medical necessity. You may refer to the original communication, appearing in the October 2021 BlueLink.
Observation Services Limited to 72 Hours
As we continue to ensure our members are consistently receiving the right care at the right time and the right level observation services are limited to 72 hours effective January 1, 2023. After this time, the member should be admitted or discharged to a lower level of care. CareFirst will continue to review for medical necessity when claims are submitted. Please note this update to the notification requirement: the notification requirement originally shared in the November communication has been removed with the exception of BlueChoice HMO members whose benefits still require notification for observation level of care.