Changes to How Diagnostic Tests Performed During a Wellness Visit are Processed

Changes to How Diagnostic Tests Performed During a Wellness Visit are Processed

November 17, 2017

Blue Cross and Blue Shield of North Carolina (BCBSNC) is changing the way it processes diagnostic tests that occur during a wellness visit for all fully insured plans. This change will take effect January 1, 2018 or upon your renewal if at a later date and will likely impact your covered members.

For all non-grandfathered plans, BCBSNC will deny diagnostic services used for preventive care or screening purposes, as they are not recognized as recommended preventive services (Grade A or B) by the United States Preventive Services Task Force.

If a member receives diagnostic tests that are not part of approved ACA tests, the claim will be completely denied.  The member may then be responsible for requesting that the provider code the tests separately and resubmit them to BCBSNC. That will allow the preventive portion of the visit to be covered at 100%, and the diagnostic tests be applied to any applicable deductible and coinsurance.

Based on guidance from BCBSNC, this includes but is not limited to: Urinalysis Testing, Thyroid function testing, Vitamin D serum testing, EKGs, Testosterone level testing, Vitamin B serum testing, Albumin (urine) testing, Iron level testing, Chest x-rays.

This flyer offers guidance to members on how to have appropriate conversations with their physician.

EMPLOYEE COMMUNICATION

Below is a simplified message you can use to communicate this change with your employees.

Upcoming Change for Diagnostic Tests Given During a Wellness Visit

Effective on our plan renewal date, January 1, 2018 or after, Blue Cross and Blue Shield of North Carolina (BCBSNC) will change the way preventive care visit claims are processed when a diagnostic test was performed at this visit.  If specific diagnostic tests are performed and submitted with the preventive care claim, BCBSNC will deny the claim.  Based on guidance from BCBSNC, these tests include, but are not limited to: Urinalysis Testing, Thyroid function testing, Vitamin D serum testing, EKGs, Testosterone level testing, Vitamin B serum testing, Albumin (urine) testing, Iron level testing, and Chest x-rays.

If you or a covered dependent receives a diagnostic test that is not an ACA approved diagnostic text, your claim could be completely denied.  Depending on your provider, you may may be responsible for requesting that the provider code the tests and visit separately and then resubmitted to BCBSNC.

Please review this helpful guide prior to having conversations with your physician.