Current News

 

 

 

News/Events for HNS 
Healthcare Professionals

 

 

This section of our website provides access to important information to help you stay up-to-date with payors and HNS' policies and procedures,  care guidelines, changes in the industry, health related news, HNS seminars and events and more.

 

     

 

Please check this section often for important news and updates.  

 

Email - Because we use email as our primary means of communicating important information, please immediately logon to HNSConnect® if your email address changes, and provide HNS with your current email address.

 

  10/31/2024 - BCBS's Physical Therapy PA Program & Billing Non-Covered Services

  Dear Providers,
  Now that BCBSNC has moved the effective date of its prior authorization (PA) program for physical therapy (PT) services to December 1st, HNS has received several questions about what that means for coverage of mechanical traction (97012) and unattended electrical stim (97014), as well as other related coverage questions.
   
  To address many of those questions, HNS would like to highlight the following key points:
 
  • Fully Insured BCBSNC Commercial Plans Will Cover 97012 & 97014 Through 11/30/2024
  Because the effective date of the PA Program has been moved, BCBSNC fully insured commercial plans will continue to cover mechanical traction (97012) and unattended electrical stim (97014) through 11/30/2024, and thus, you must submit claims to BCBSNC for those services from now until DOS 11/30/2024 and may not bill the patient directly for them. Beginning with DOS 12/1/2024-the new effective date of the program-those services will be considered non-covered for fully insured plans, and as long as you have an appropriately signed non-covered services waiver, you may bill the patient directly for those services starting with services rendered on that date.
 
  • Coverage of 97012 & 97014 by Non-Fully Insured BCBSNC Commercial Plans
  After the new PA program goes into effect on 12/1/2024, as we know, it only applies to BCBSNC fully insured commercial plans. As such, for any plan that is not a BCBSNC fully insured commercial plan, mechanical traction (97012) and unattended electrical stim (97014) will continue to be covered as normal. Thus, unless you specifically obtain a written verification of benefits from such a plan, which complies with HNS policy and proves that these services are not covered, you must always file claims for these services and may not bill the patient directly, even if you have a non-covered services waiver. For the avoidance of confusion, FEP, SHP, and all self-funded plans, that HNS is aware of, will continue to cover these services.
 
  • HNS Providers Are Required to Continue to Submit Claims for Covered Services
  Importantly, HNS contracted providers must continue to appropriately submit claims for all covered services for all BCBSNC patients, even if their plan is subject to this new PA program. With the exception of certain requests for restrictions of disclosure of health information, there is no general insurance waiver that providers may obtain that will allow them to avoid this requirement. Please see the following policy for more information: https://healthnetworksolutions.net/index.php/election-not-to-file-entf-forms
 
  • Billing of PT Services Denied as Not Medically Necessary
  The above being said, and as previously indicated, if the PA program ultimately determines that a PT service or a visit with PT services is medically unnecessary and no further PA will be authorized, those impacted services would be considered non-covered and may be billed to the patient if an appropriate non-covered services waiver is obtained prior to the treatment being performed and is on file in the patient's healthcare record. For more information on the proper procedure for billing patients for non-covered services, please consult HNS' Non-Covered Services Policy found here: https://healthnetworksolutions.net/index.php/non-covered-services
   
  For more information about the forthcoming BCBSNC Physical Therapy Prior Authorization Program, please:
   
 

Click Here to Access

the Most Recent Version of the 

BCBSNC Physical Therapy Authorization Summary Sheet
   
  Sincerely,
  HNS

 

  10/30/2024 - Effective Date of BCBSNC Physical Therapy PA Program Now 12/1/2024

  Dear Providers,
  BCBSNC has informed HNS that the outstanding issues with accessing the Carelon online prior authorization (PA) portal have been resolved and that the new effective date of the program is for dates of service on or after 12/1/2024.
   
  At this time, you should be able to access the Carelon portal through your Blue E account and will be able to begin submitting PA requests for physical therapy (PT) services for fully insured BCBSNC members when required. Please note, however, that requests cannot be submitted more than 30 days in advance of the first treatment visit requiring PA.
   
  Registration instructions for Blue E, how to access Carelon's online portal through Blue E, the timeframes for submitting PA requests, and other helpful updates have been added to HNS' BCBSNC Physical Therapy Prior Authorization Summary Sheet, linked below.
   
 

Click Here to Access

the Most Recent Version of the 

BCBSNC Physical Therapy Authorization Summary Sheet
   
  To help ensure that you properly login to the PA portal, please carefully review Section 1 in this document in its entirety before accessing the portal the first time. 
   
  Moreover, to properly obtain PA and avoid denials, please be sure you and your billing CA thoroughly understand this new PA program and follow all directions included in this document.
   
  HNS will continue to update the BCBSNC Physical Therapy Prior Authorization Summary Sheet, as well as the BCBS-Carelon section of the HNS website, with any additional important information we learn about the BCBS PA program, and will also notify the network of any pertinent updates.
   
  Sincerely,
  HNS

 

  10/25/2024 - IMPORTANT UPDATE: Effective Date of BCNC Physical Therapy PA Program Changing

Dear Provider,
As you know, providers are still unable to properly access the Carelon online prior authorization (PA) portal. BCNC has resolved one technical error causing this problem and is actively working on the other. HNS has held several meetings and communicated multiple times with BCNC each day about this issue, and we will continue to do so until it is fully resolved.
 
Importantly, during those many meetings and various communications, HNS repeatedly insisted that BCNC, at a minimum, move back the effective date of the new PA program for physical therapy (PT) services until the portal issue was fully resolved. 
 
As a result of those efforts, we are happy to report that BCNC has now agreed to do just that. The PA program will not go into effect on 11/1/2024 as intended, but at some date after the portal issues have been resolved. For the time being, BCNC is not requiring you to request PA for PT services.
 
BCNC intends to issue more details about the extension of the program’s effective date in the coming days. Once they do, HNS will immediately communicate that information to you. For now, this is all the information we have about this change, but we wanted to share it with you as soon as we knew.
 

Sincerely,

HNS

 

  10/24/2024 - Non-Covered Services Waiver - E-Stim and Traction

  Dear Provider,
  Unfortunately, as we know, the new BCNC physical therapy (PT) prior authorization (PA) program does not consider Mechanical Traction (97012) or Unattended Electrical Stim (97014) to be medically necessary. As such, BCNC will no longer cover these services for patients of BCNC fully insured commercial plans effective 11/1/24.
   
  Importantly, however, you may still get paid for performing these specific services on BCNC fully insured commercial patients by collecting appropriately signed non-covered services waivers and billing the patients directly, without having to first request PA.
   
  To assist you in this regard, HNS has created a Non-Covered Services Waiver for Traction and E-Stim form, which you may use for patients of fully insured BCNC commercial plans (effective 11/1/24), or any other patient of an insurance plan that does not cover these services.
   
  Click Here for Your Copy of the Non-Covered Services Waiver for Traction and E-Stim
   
  You may also find a copy of this Waiver, as well as other helpful forms, under the Forms Section of the HNS Website. 
   
  For more information on the proper procedure for billing patients for non-covered services, please consult HNS Non-Covered Services Policy found here: https://healthnetworksolutions.net/index.php/non-covered-services.
   
  Sincerely,
  HNS

 

  10/22/2024 - Providers Still Unable to Access BCBS-Carelon PA Portal

Dear Provider,
Unfortunately, despite what BCBS previously informed us, providers are still unable to access the Carelon online prior authorization (PA) portal through Blue E at this time. HNS fully understands that this is extremely frustrating and creates even more of an administrative burden for you all. We have already been in communication with BCBS this morning about this issue and they are working to resolve it. 
 
Moreover, because the 11/1/24 effective date is rapidly approaching, we have also insisted that BCBS move back the effective date of the new PA program for physical therapy (PT) services until this issue is resolved. As of now, however, BCBS has not agreed to do so. Therefore, and unfortunately, the only method for requesting PA at this time is by calling Carelon at 1-866-455-8414.
 
HNS will notify you as soon as the online PA portal is available through Blue E. In the meantime, if you do not currently have a Blue E account, you need to register for one as soon as possible in order to access the Carelon online PA portal once the current access issues have been resolved. To do that, please complete the following form and fax it to 919-765-7101.
Click Here for Blue E Registration Form

Sincerely,

HNS

   10/21/2024 - Update: Providers will Access BCBS-Carelon PA Portal Through Blue E Starting 10/22/24

Dear Provider,
BCBS recently informed HNS that providers will now access the Carelon online prior authorization (PA) portal through Blue E in order to submit PA requests for physical therapy (PT) services to be provided on or after 11/1/24 to fully insured BCBS members. 
 
According to BCBS, due to a technical issue, access to the online PA portal through Blue E for most providers will not be available until tomorrow, 10/22/24. If you wish to request PA prior to tomorrow, you may do so by calling Carelon at 1-866-455-8414.
 
Importantly, if you do not currently have a Blue E account, you need to register for one as soon as possible in order to access the Carelon online PA portal. To do that, please complete the following form and fax it to 919-765-7101.
 
Click Here for Blue E Registration Form
 
If you have any questions about completing this form, please do not hesitate to contact your HNS Provider Representative. HNS will notify the network once the online PA portal is available through Blue E.
 

Sincerely,

HNS

  10/15/2024 - BCBSNC Physical Therapy Prior Authorization Summary

Dear Provider,  
Unfortunately, BCBS and Carelon are still experiencing issues, which are preventing providers from properly registering for the Carelon portal. They are working diligently to address these issues, and we will notify you once they have been resolved and provide portal registration instructions at that time.
 
In the meantime, to assist you with the new BCBS prior authorization (PA) for physical therapy (PT) requirement (effective 11/1/2024), HNS has created a "BCBS-Carelon" section of the HNS Website, which you may access here:
 
BCBS / Carelon PA for PT Program (healthnetworksolutions.net)
 
Importantly, in addition to select resources from Carelon, this new section contains HNS' newly created "BCBSNC Physical Therapy Prior Authorization Summary Sheet" which outlines important details we currently know about this new PA program. 
 
Click Here to Access the BCBSNC Physical Therapy
Prior Authorization Summary Sheet
 
To help ensure you properly obtain PA and avoid denials, please be sure you and your billing CA understand this new program and follow the directions included in this document.
 
HNS will continue to update the BCBSNC Physical Therapy Prior Authorization Summary Sheet, as well as the new BCBS-Carelon section of the HNS website, with any additional important information we learn about the BCBS PA program, and will also notify the network of any pertinent updates.
 
Sincerely,
HNS
 

     9/30/2024 - Update: BCBSNC Fully Insured Plans Will Require Prior Authorization for Physical Therapy Codes Effective 11/01/2024

Dear Provider,
As you know, effective 11/1/2024, BCBSNC will require that all providers obtain prior authorization (PA) for physical therapy (PT) codes billed to fully insured plans. 
 
HNS strongly disagrees with this policy, and like you, we are extremely frustrated and concerned about its impact. We continue to work with BCBSNC to obtain clarification regarding specifics surrounding how this policy will work for HNS providers and will provide you with updated information as we have it. 
 

In the meantime, we are outlining some important action steps you should take.
 
ACTION STEP #1: Carefully Review the Following Information with All Pertinent Staff Members. 
 

 

-The Policy: Effective 11/1/2024, for all BCBSNC fully insured plans, all PT services, following those performed on the patient's initial visit (i.e., all DOS following the visit where the new patient E/M code is billed) will require prior authorization (PA) in order to be reimbursed.
 

 

Utilizing the clinical guidelines linked below, the program will consider individual clinical details, and services to be rendered, to determine the number of visits (where PT services are to be performed) to authorize. 
   
 

-Impacted Plans:  This new PA requirement only applies to Fully Insured Commercial BCBSNC Plans. At this time, it will not apply to FEP, SHP, out-of-state plans, or self-funded employer plans.
   
 

-Impacted Services:  The PT services triggering the PA requirement, include, but are not limited to services represented by the following codes:
  97010, 97012, 97014, 97016, 97024, 97026, 97032, 97034, 97035,
97110, 97112, 97124, 97140, 97530, 97750, 97760, 97763
   
  Importantly, under this new policy, you will not be required to obtain PA for any service that is not a PT service (e.g. E/M, x-ray, and CMT services will not require PA.)
   
 

-Important Note - 97012 & 97014: Unfortunately, the Clinical Guidelines governing this PA program, which are linked below, seem to indicate that PA will never be granted for Traction (97012) and Unattended Electrical Stim (97014) because the Guidelines state these services are never considered medically necessary. As this is a substantial change to BCBSNC policy, we have asked that they clarify whether we have interpreted this correctly and will report back to the network once we know more.
   
 

-Therapy Modifier:  To process claims correctly, Modifier GP will be required on all E/M and treatment code lines. (Note: HNS is seeking additional clarification on this requirement as it relates to CMT codes billed on the same DOS as any PT service.)
   
 

-How to submit a PA request:  Beginning on 10/21/2024, you will be able to submit PA requests for DOS on/after 11/1/2024 as follows:
 
  Online:  Through the Carelon provider portal, which is available 24/7 and processes requests in real-time based on the Clinical Guidelines linked below. (You will need to register for this portal when first attempting to use it and may find details about registering in the FAQs linked below.)
   
  By phone:  Providers may also call Carelon, M-F (8am-5pm ET) at 1-866-455-8414.
   
  Importantly, on 10/21/2024, you should begin entering and seeking PA for patients on established treatment plans which include PT services that will be rendered on and after 11/1/2024 to ensure you have ample time to obtain the required PA for those patients. 
   
 

-Identifier to Use When Requesting PA:  When seeking to obtain PA for PT services, you will use HNS' NPI (1093773392) for all authorization requests.
   
 

-Billing of PT Services as Non-Covered:  If the PA program ultimately determines that a PT service or a visit with PT services is medically unnecessary and no further PA will be authorized, those impacted services would be considered non-covered and could be billed to the patient under the right circumstances. Because there will be several requirements associated with this, HNS will be emailing you separately regarding this topic.
 
 Action Step #2: Carefully Review the PA Program's Applicable Guidelines, FAQs, and Checklist. 

 

-Carelon Medical Benefits Management (Carelon) will manage the PA process on behalf of BCBSNC, and BCBSNC will utilize Carelon's clinical guidelines to determine when and how to grant PA.

 

-For your review and reference, we have embedded those guidelines, along with related FAQs and an informative checklist about the program here:  BCBSNC-Carelon PA for PT Guidelines, FAQs, and Checklist. Please click this link and review these documents yourself. Then review them with pertinent members of your team. 
 
Action Step #3: You and Pertinent Staff Should Attend One of the PA Program's Training Webinars.

 

-In addition to carefully reviewing the information above with your staff, we strongly recommend that you and your staff attend one of Carelon's upcoming online training sessions to learn more about the PA process. HNS will be attending these sessions as well so that we may better help you understand this program.

 

-The webinars are currently scheduled for 12:00pm on October 2nd, 16th, 30th, and November 6th. You may visit the following link (and scroll to the bottom of the page) to register for one of the sessions:  Changes in prior authorization for Blue Cross NC outpatient therapy requests effective November 1.

 

In closing, we want to again reiterate, that like you, we believe this PA requirement is unnecessary and should not apply to HNS providers. However, BCBSNC has decided to leave it in place, and as such, over the coming weeks, HNS will continue to provide you with helpful information and materials to help make sure you all are well equipped to navigate the process. 
 
Sincerely,
HNS 

 

   9/12/2024 - BCBSNC Fully Insured Plans Will Require Prior Authorization for Physical Therapy Codes

Dear Provider,
Late yesterday, BCBSNC informed HNS that it does not intend to exempt chiropractors from the requirement (effective 11/1/2024) to obtain prior authorization for physical therapy codes billed to fully insured plans. 
 
We strongly disagree with BCBSNC's decision, and like you, are frustrated and disappointed in this outcome. We maintain our position that HNS providers should be exempt from this requirement. However, we are now working to obtain additional information that will be necessary for you to comply with and navigate this new requirement. 
 
As we learn more pertinent information, we will continue to share it with you. 
 
In the meantime, please refrain from asking your HNS Service Representative questions about this new PA requirement. They are busy working on your other inquiries, and currently, have no additional information to share about it. 
 
Sincerely,
HNS 

 

   9/4/2024 - Update: BCBSNC Notice Regarding Prior Authorization for Physical Therapy Codes

Dear Provider,
As some of you may have seen, BCBSNC recently posted a notice on its website containing additional detail about its requirement (effective 11/01/2024) that all providers obtain prior authorization for most Physical Therapy codes billed to fully insured plans. 
 
For your convenience, you may find the notice by clicking the following link:
Changes in prior authorization for Blue Cross NC outpatient therapy requests effective November 1.
 
Importantly, HNS remains in constant communication with BCBSNC concerning our request to exempt HNS providers from this requirement, which remains under consideration. However, because the outcome is uncertain, we did want to share a link to the above notice as soon as possible. 
 
Finally, after reviewing the notice, you may likely have more questions, as does HNS. Thus, while we are advocating for HNS providers to be exempt, please know that we are also seeking additional detail about the new requirement and will continue to share pertinent information with you. 
 
Sincerely,
HNS

 

   8/21/2024 - Update: BCBSNC Implementing Prior Authorization for Physical Therapy Codes

Dear Provider,
As HNS previously reported, BCBSNC recently informed us of its intention to add most Physical Therapy codes to the list of codes requiring prior authorization for its fully insured plans, and that this change would apply to all provider types, including chiropractors. 
 
While we remain in staunch opposition to this requirement for HNS providers and continue to vigorously advocate for our providers to be exempt, we did want to let you know that the effective date of this new policy has been moved to November 1st for the time being. 
 
We will continue to provide you with additional details regarding this new policy and our efforts when we have more information to share. 
 
Sincerely,
HNS

 

  7/29/2024 - BCBSNC Implementing Prior Authorization for Physical Therapy Codes

  Dear Provider,
  HNS recently learned that, effective 10/1/2024, BCBSNC intends to add most Physical Therapy codes to the list of codes requiring prior authorization for its fully insured plans, and that this change would apply to all provider types, including chiropractors.
   
  HNS staunchly opposes the requirement for HNS providers to obtain prior authorization for any service and has been in communication with BCBSNC representatives over the past several weeks concerning this forthcoming change. 
   
  Importantly, we are advocating for HNS providers to be exempt from this change and are working with BCBSNC to obtain additional details. However, we wanted to share the following with you now:
   
 
  • Effective 10/1/2024, for all BCBSNC full insured plans, most Physical Therapy codes will require prior plan approval, including, but not limited to:
  97010, 97012, 97014, 97016, 97024, 97026, 97032, 97034, 97035,
97110, 97112, 97124, 97140, 97530, 97750, 97760, 97763
 
  • This requirement will apply to all provider types, not just chiropractors.
 
  • As indicated above, this requirement will only apply to BCBS fully insured plans, meaning it will not apply to self-funded groups, FEP, or SHP.
  Over the coming weeks, HNS will be focused on learning more details about the change and advocating for HNS providers to be exempt from it. While HNS hopes BCBS grants this exemption, the outcome is far from certain. As such, at this time, all HNS providers should be aware that this change is slated to take effect 10/1/2024. 
   
  We will be communicating with the entire HNS Network again once we have more information to share. 
   
  Sincerely,
HNS