Schedule of Maximum Allowances Annual Update – Effective June 1, 2014

Posted March 20, 2014

In an effort to comply with fairness in contracting legislation and keep our independently contracted providers informed, Blue Cross and Blue Shield of Illinois (BCBSIL) has designated a Fairness in Contracting column in the Blue Review provider newsletter to notify you of any significant changes to the physician fee schedules. Be sure to review this area of the newsletter each month. Information also may be posted in the News and Updates section of the Provider website. 

Effective June 1, 2014, BCBSIL will implement its annual update of the Schedule of Maximum Allowances (SMA) in relation to the Centers for Medicare & Medicaid Services (CMS) Resource Based Relative Value Scale (RBRVS) revisions and CMS fees for DME Supplies, Prosthetics, Orthotics and clinical laboratory codes. Reimbursement for services provided on or after June 1, 2014, will be based on the updated fee schedule. This update affects PPO and BlueChoice Select fee schedules for professional providers. Providers may request fee schedules for this update starting May 27, 2014. 

A Reminder to Providers: Please do not contact the BCBSIL Provider Telecommunications Center (PTC) for National Drug Code (NDC) Fee Schedules. You can locate your NDC fee schedule by registering for Blue Access for ProvidersSM, BCBSIL’s secure provider portal. To log in or register, look for the National Drug Codes (NDCs): Billing Resources box on our Provider Home page. Note: First time registration must be completed by someone of authority at your practice, such as the Office Administrator. Completion of the registration process will designate you as the "Super User." The Super User will be responsible for adding users and delegating roles. 

The information above is not intended to be an exhaustive listing of all the changes. Annual and quarterly fee schedule updates can also be requested by using the Fee Schedule Request Form, which is available in the Education and Reference Center/Forms section. This form also may be used to request updates on specific code changes that are referenced in the Blue Review.