BLUECONNECT

Providers

August 2024

In This Issue

►	August news: Executive summary

►	AZ Blue remits are now available on Availity Essentials

►	Coverage guideline update for GLP-1 drugs

►	Reminder: Quarterly fee updates and code edit changes

Reminder: Quarterly fee updates and code edit changes

To support accurate claim processing, we update our proprietary fee schedules each quarter. We also update our claim editing software with code edit changes from time to time.

How to preview the upcoming fee schedule changes

Our next quarterly fee updates will be effective October 1, 2024. You can preview them on the provider portal starting September 1, 2024. To find them, log in to the AZ Blue portal and go to “Provider Resources > Guidelines > Claim Pricing.” Then select one of the “Fee Updates” links to view or download the updates for ASC, Outpatient, Professional, Unclassified Drug, or Per Diem Base Rates.

Note: This article and the online posting of the updates serve as our formal advance notice of these fee schedule changes—as required by our AZ Blue participation agreements.

Our fee schedule changes

We base our commercial fee schedules on a number of pricing sources that can influence the need for changes. These include:

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Medicare fee schedules

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Information derived from claims

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Competitive pricing data

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Feedback from AZ Blue network providers

Our fee updates may also reflect generally applicable market changes, such as:

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CMS code changes

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Pricing for newly available drugs

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Fluctuations in prices for listed drugs

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Other market shifts

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Correction of over- or under-valued fees

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Modifications based on ongoing utilization analysis

Our code edit updates

We updated our code edits as needed to include:

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New CDT^®/CPT^®/HCPCS procedure codes

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AZ Blue Code Edit Guidelines updates

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Correct Coding Initiative (CCI) releases (quarterly)

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Other code edit changes

These updates can impact pricing for certain professional and outpatient claims.

For information about AZ Blue code edit rules, check out the current Code Edit Guidelines PDF. This document includes effective dates for when rules were or will soon be applied.

How the C3 transparency tool can help

To see how our code edits are likely to impact your claims, please use the Clear Claim Connection™ (C3) code edit transparency tool. The tool displays current AZ Blue payment policies, related rules, code edit clarifications, and source information. The tool does not support dental claim code edits.

How to access our Code Edit Guidelines and the C3 tool

You can find our Code Edit Guidelines and the C3 tool on the AZ Blue portal at “Provider Resources > Guidelines > Claim Coding > Code Edit Guidelines and C3 Tool.” We post revisions to the Code Edit Guidelines as needed.

If you have questions about fee schedules or code edits, feel free to reach out to your Provider Relations Contact or call us at 1-800-232-2345, ext. 4231.

In This Issue

►	August news: Executive summary

►	AZ Blue remits are now available on Availity Essentials

►	Coverage guideline update for GLP-1 drugs

►	Reminder: Quarterly fee updates and code edit changes

CDT (Current Dental Terminology) codes are © 2024 American Dental Association. CDT is a registered trademark of the American Dental Association. All rights reserved.

CPT (Current Procedural Terminology) codes are © 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

The Clear Claim Connection tool is owned by Lyric, a separate, independent third-party vendor that is solely responsible for its products and services.

Blue Cross, Blue Shield, the Cross and Shield Symbols, are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

© 2024 Blue Cross Blue Shield of Arizona, Inc. All rights reserved.

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