Preventive Colonoscopy Claims

November 30, 2012

The Affordable Care Act (ACA) Preventive Services provision requires coverage of preventive services, including colorectal cancer screening without member cost-sharing when the member is covered by a non-grandfathered group health plan. For BCBSIL members, this means the preventive service must be covered with no coinsurance, deductible or copay when the patient covered under a non-grandfathered group health plan uses independently contracted providers in the BCBSIL network. 

For answers to frequently asked questions (FAQs) about colonoscopy claims, visit the Preventive Colonoscopy Claim FAQs  located in the Standards and Requirements/Coding Related Updates section. 

This material is for informational purposes only and is not the provision of legal advice. If you have any questions regarding the law, you should consult with your legal advisor. 

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.