The federal government has rescinded many of the requirements put in place during the COVID-19 Public Health Emergency (PHE). The following changes will be effective May 11, 2023

Help Keep Your Provider Data Current | 5/4/23

Updating your information can ensure you’re meeting federal requirements for provider data

How To Submit a Corrected Claim | 5/4/23

The preferred process for submitting corrected claims is to use the 837 transaction for both professional and facility claims, and the claim frequency code 7

Health Sector Coordinating Council Releases “Cybersecurity for the Clinician” Video Training Series | 5/4/23

This series explains the basics for how cyber-attacks can affect clinical operations and patient safety

New Edits for Drug Waste on Professional and Facility Claims | 4/6/23

Review the details in these policies to learn how to correctly code for drug wastage

End of the Public Health Emergency Brings Changes to Payment Policies | 4/6/23

LifeWise will be updating payment policies to reflect the federal government ending the COVID-19 public health emergency

New Quality and Coding Tools for LifeWise Providers | 4/6/23

Visit our new web page for quality measures and coding tip sheets

Optum Financial Moves to Virtual Credit Card Payment | 4/6/23

You can change your payment method through Optum Financial

AIM Specialty Health Transitioned to Carelon | 5/1/23

AIM Specialty Health changed its name to Carelon Medical Benefits Management on March 1, 2023

Keep Your Provider Data Current | 3/2/23

Information to help you ensure you’re meeting federal requirements for provider data

Supporting Providers in their Health Equity Journey | 2/2/23

Visit the Provider Learning Center to access training on equity, cultural competency, bias, diversity, and inclusion

AIM Specialty Health Transitions to Carelon | 4/6/23

AIM Specialty Health will have a new name, Carelon, on March 1, 2023

LifeWise is Prepared to Support Members’ Urgent Behavioral Health Needs | 1/5/23

LifeWise customer service and case management teams are ready to help members get next-day appointments

Prior Authorization for Cancer Biomarker Testing Waived | 12/1/22

Starting January 1, 2023, prior authorization will be waived for certain biomarker testing for Washington members living with cancer

Preventive Services Updates for 2023 | 12/1/22

Changes to our preventive care benefits are coming in January

Making Provider Directory Accuracy a Priority | 12/1/22

LifeWise is working with BetterDoctor to ensure the accuracy of your information in our provider directory

Reminder: Title Revision for Physical, Occupational, and Speech Therapy Services Payment Policy | 10/6/22

In July 2022, the title of physical, occupational, and speech therapy services payment policy was updated and the policy code 97127 was removed

Upcoming Changes to CPT Evaluation and Management Coding | 10/6/22

The American Medical Association revised the E&M coding guidelines and code descriptions

Premera Expands BlueHPN to Washington Members | 10/6/22

Blue High Performance Network (BlueHPNSM) supports employer groups to improve health outcomes

Prior Authorization Waived for Cancer Biomarker Testing | 11/1/22

Change in 2023 for Washington members living with cancer

New Payment Policy: Place of Service Codes | 9/1/22

Learn more about place of service (POS) codes that don’t reflect where a service was performed or received

Changes to Group Psychotherapy Policy | 9/1/22

Policy exceptions being removed from policy

Botulinum Toxins will Require a Prior Authorization | 9/1/22

Provider Directory Notice: Check Your Status with BetterDoctor | 9/1/22

Premera is working with BetterDoctor to ensure the accuracy of your information and meet provider directory requirements in the federal No Surprises Act

DataWise: Premera’s Interoperability Program | 8/4/22

See how interoperability data sharing can help close gaps and improve health outcomes

Provider Taxonomy Codes Needed on Claim Forms | 7/7/22

Add your specialty taxonomy code to claims to assist in correct editing

Washington State Health Care Authority Survey | 6/2/22

The Health Care Authority is reaching out to primary care providers to help shape implementation of the Washington Primary Care Transformation Model

Preventive Services Updates For 2022 | 6/2/22

Learn about changes to our preventive care benefits

Washington State Legislature Sets Guidelines for Telehealth | 7/7/22

Starting October 7, 2022, providers with 11 or more practitioners will return to agreed fee schedule in their contract

New Payment Policy: COVID-19 Testing | 6/7/22

Diagnostic testing, surveillance testing and over the counter tests reviewed

Prevent Claim Edits and Denials with These Tips | 11/16/22

If a procedure code doesn’t match the anatomic site of the modifier, the procedure code will be denied - learn more tips!

Prevent Claim Edits and Denials with These Tips | 11/16/22

Audio-only services need to be identified by adding one of the new audio-only modifiers

Over-the-Counter COVID-19 Testing and Government Tests | 6/7/22

Health plans are required to cover member-purchased over-the-counter (OTC) COVID-19 tests

New Code for Post COVID-19 Conditions | 1/6/22

This code is for conditions which are the consequence of COVID-19

Gender Affirming Treatment Law Now in Effect | 1/6/22

Starting January 1, 2022, transgender health care coverage will be extended in Washington

AIM Provider Portal Changes | 1/6/22

AIM provider portal allows users to see the order ID on all authorization requests

Enhanced Edits Based on Provider Specialty | 1/6/22

Provider’s specialty and tax identification number will be used to determine application of edits

No Surprises Act: Understanding Balance Billing Rules | 12/16/21

Learn about the balance billing rules coming with the No Surprises Act in 2022.

Understanding the No Surprises Act Dispute Resolution Process | 12/16/21

Learn about the new federal dispute resolution provisions starting January 1, 2022.

Update to Preventive Services: Colorectal Cancer Screenings | 12/16/21

Learn about an age range change to our preventive benefits for colorectal cancer screenings.

Telehealth Place of Service Code | 12/16/21

New place of service code for telehealth provided in patient’s home.

Pediatric COVID-19 Vaccine Codes and Eligibility | 11/18/21

Vaccine codes are now available for children ages 2-11.

Codes and Eligibility for COVID-19 Booster Shots | 11/18/21

Use the correct codes when submitting claims for COVID-19 vaccines and boosters.

Telehealth/Virtual Encounter Documentation and Billing Guidelines | 11/4/21

Correctly code your telehealth encounter for reimbursement.

Billing for Delivery and Postpartum Care Services | 11/4/21

Only one submission of postpartum care will be allowed per pregnancy

Understanding Provider Directory Requirements for the No Surprises Act | 11/4/21

Learn about the new provider directory rules starting January 1, 2022.

Federal No Surprises Act Explained | 10/21/21

Prior authorization and site of service will be required for hysterectomy for dates of service January 7, 2022 and beyond

Prior Authorization Required for Hysterectomy Surgeries in 2022 | 10/7/21

Prior authorization and site of service will be required for hysterectomy for dates of service January 7, 2022 and beyond

Extending Length of Approval for Prior Authorizations | 9/16/21

LifeWise has extended the length of approval for prior authorizations to 180-days

Inpatient Stays will Require Pre-Certification for FEP Members | 9/16/21

If a precertification isn’t done for FEP inpatient stays, payments will be reduced

LifeWise Adds Two New Counties in 2022 | 9/16/21

LifeWise plans will now be in 35 counties

New Payment Policy: Therapy Assistant Modifiers | 9/16/21

Physical therapy and occupational therapy assistant modifiers now required

Update to PrEP Preventive Services Coverage | 6/7/22

Learn about an important change to our preventive care benefits for pre-exposure prophylaxis

Prior Authorization Requirements Temporarily Waived for SNF Transfers | 9/16/21

We’re temporarily waiving the prior authorization requirement for skilled nursing facilities

Hospital and Hospital System Readmission Payment Policy Revisions | 9/2/21

Find out more about significant content changes to this policy

Help LifeWise Provide Timely and Efficient Care for Our Members | 9/2/21

The network awareness survey ensures our providers and staff are aware of our available networks

Third COVID Vaccine Dose Approved | 8/19/21

A third dose is recommended for patients with moderate or severe primary immunodeficiency

Philips Respironics Recalled Ventilators, BiPAP and CPAP Machines | 8/19/21

Learn more about the Philips Respironics recall

New Tools to Estimate Patient Costs will be Introduced in 2022 | 8/5/21

The real-time estimator tool no longer available

Are you set up to provide COVID-19 Vaccine Counseling for your patients? | 7/2/21

Executive Order 21-02 allows for billing for vaccine counseling

COVID Treatment Cost Shares ends June 30 | 6/3/21

The COVID treatment cost share waiver will end on June 30, 2021

Preventive Services Updates for 2021 | 6/3/21

Learn about changes to our preventive care benefits

Payment Policy Revisions | 6/3/21

Recent revisions to payment policies affect claims payment

New Policy for Lab Billings | 6/3/21

Billing guidelines for laboratory and pathology services

Annual Risk Adjustment Data Validation Audits | 7/2/21

Offices may receive a request for medical records from Cognisight or LifeWise

Transparency in Coverage Rule | 4/15/21

What is this new rule and what will LifeWise do to comply

Contract Exclusions Payment Policy | 4/15/21

Edits will be enforcing correct coding of diagnosis codes and procedure codes. Clarification for the Contract Exclusions payment policy

OneHealthPort Multi-Factor Authentication Begins on May 10 | 4/15/21

Multi-Factor Authentication will be added to the OneHealthPort Single Sign-On service

Patients Can Get More Control of Their Health Data | 4/16/21

New rules require health plans to provide patient clinical records access within 24 hours

Upcoming Facility and Professional Claim Edits | 3/4/21

Edits will be enforcing correct coding of diagnosis codes and procedure codes.

New Codes for Coronavirus and Vaccines | 2/4/21

Providers must use new ICD-10 codes.

Changes to The Appeals Process | 1/21/21

Signed member authorization required for appeals submitted on member’s behalf.

Updated Virtual Care Benefits | 1/7/21

IOP and PHP virtual care are now standard benefits.

New Steps for Admission Notification | 1/7/21

You now have more time to submit medical records for admissions.

Has Your Office Information Changed Recently? | 1/7/21

Make sure your information is also current in our provider directory.

COVID-19 Vaccine Updates | 12/17/20

What you need to know to administer the vaccine.

COVID-19 Vaccine Updates | 1/7/21

What you need to know to administer the vaccine.

New Law Brings Changes to Inpatient Substance Use Treatment Services | 12/17/20

House Bill 2642, the “No Wrong Door” Substance Use Treatment Accessibility Act, establishes new utilization management standards for health plans and providers.

Modifier 90 Edit Expansion to Facility Claims Rescinded | 12/3/20

Coding edits for modifier 90 won’t be expanded to facility claims.

Reimbursements for Some September Telehealth Claims | 11/19/20

We’re reprocessing telehealth claims providers submitted to reimburse at the in person allowed amount.

2021 Individual Plans | 11/5/20

New network for 2021 Individual Plans.

Payment Policy: Personal Protective Equipment | 11/5/20

Personal protective equipment (PPE) will no longer be separately reimbursable.

Virtual Care Documentation Best Practice | 11/5/20

Are you documenting all the elements of a telehealth visit?

LifeWise Extends the POS Payment of Telehealth Visits | 10/15/20

Providers need to continue use the telehealth place of service (POS) 02 with the procedure code appended with either modifier 95 or GT.

Modifier 90 Edit Extending to Facility Claims | 10/15/20

Correct coding edits for modifier 90 will apply to facility claims.

Billing Telehealth Services | 10/1/20

Providers need to bill POS 02 for all telehealth services delivered after September 1.

Complete the Provider Network Survey | 10/1/20

Tell us how to improve our network information.

Home Test Kits for Members in Alaska and Washington | 9/17/20

Annual FIT and HbA1c home test kit program launches in mid-September.

Participate in Provider Network Awareness Survey | 9/17/20

We’re working to ensure our ongoing efforts lead to timely and efficient care for our members.

Updates to Claim Editor/What If Tool | 9/17/20

Check your claim in the What If Tool to identify potential edits.

Upcoming New Professional and Facility Claim Edits | 9/3/20

Additional correct coding claim edits will be applied to professional and facility claims.

Coding and Billing of a Telehealth Encounter | 8/20/20

Telehealth services are returning to correct coding and billing of a telehealth encounter.

Tips for Billing a Telehealth Originating Site Fee | 8/20/20

Learn what the originating site means for telehealth services.

Coverage for Return-to-Work Antigen and Antibody Testing | 8/6/20

LifeWise will not include molecular/antigen or antibody testing for return-to-work strategies.

Reviewing HCPCS C Codes for Medical Necessity | 7/16/20

LifeWise will be reviewing HCPCS codes in the “C” series for medical necessity.

New Payment Policy: Personal Protective Equipment | 7/16/20

Personal Protective Equipment (PPE) will no longer be reimbursed.

Policy Update for Antibody (Serology) Testing | 6/18/20

Learn more about LifeWise’s benefit coverage guidelines.

Co-surgery Modifier Enforcement | 5/7/20

Co-surgeons billing on the same procedure should submit their claims with a modifier.

Robotic Surgery Edits Expand to Facility Claims | 4/16/20

The robotic surgery and computer assisted navigation payment policy is expanding to facility claims.

Sleep Equipment Replacement Units and Supplies Review Process | 2/6/20

LifeWise will review claims for replacement units and supplies.

New Outpatient Facility Claims Edits | 2/6/20

Additional outpatient APC facility edits are coming in 2020.

It’s HEDIS Time Again! | 2/6/20

Get the facts on HEDIS with these frequently asked questions.

New UB-04 Hospital Claim Validation Edits | 1/16/20

Data elements/fields on hospital claims will be reviewed for validity and correct coding.

Updates to Telehealth/Telemedicine Payment Policy | 6/12/20

Policy exceptions will be eliminated starting April 2020.

Surprise Billing Law Takes Effect in 2020 | 12/5/19

What to know about a new Washington state law protecting patients from unexpected non-contracted provider bills.

Cologuard’s DNA Test Versus Standard FIT Kits | 1/1/20

Learn why FIT Kits are just as effective for at-home colon cancer screening.

Sleep Equipment Replacement Units and Supplies Review Process | 11/21/19

AIM Specialty Health and LifeWise are changing the review of sleep supplies.

Medical Policy and Coding Updates | 11/12/19

Did you know there are new policies for solid organ transplants based on the specific organs? Learn more in the medical policies section.

Changes for Massage, Physical, and Occupational Therapy | 11/21/19

eviCore Healthcare will no longer review physical therapy, occupational therapy and massage therapy services for individual plans.

Prior Authorization for Newborn Genetic Testing | 11/21/19

LifeWise removes prior authorization requirements for some genetic testing in newborns.

| 11/11/19

Correct coding edits will be implemented in the next couple of months.

Hospital and Hospice Based Professional Services | 11/11/19

Home health professional visits in a hospice setting and hospital ER/outpatient visits must be billed on a facility claim.

Global Surgery Follow-Up Periods and Subsequent Surgery | 11/7/19

Office visits and subsequent surgery after an initial surgery must be coded correctly to be reimbursed.

Billing for Time | 11/7/19

Tips for when to bill a unit or additional code units.

Don’t Forget to Respond to the Provider Directory Survey | 10/17/19

This survey will help members find the care they need.

Prior Auth Tool Enhancements Launch October 19 | 10/17/19

The prior authorization tool will give providers more detailed information when requesting prior auth for patients.

Prior Auth Tool Enhancements Save Time | 10/3/19

We’re launching a newly enhanced prior authorization online tool.

Brennen’s Law | 10/11/19

Washington State recently passed legislation to make it easier for patients to find the behavioral health and substance use disorder care. Learn what you can do!

Provider Directory Survey | 10/11/19

This survey will help members help people find providers that offer Medication-Assisted Treatment.

Can I Bill a Consultation Code? | 10/11/19

LifeWise does not reimburse outpatient and inpatient consultation codes.

When Do You Bill an “Add-On” Code? | 10/11/19

Add-on codes are “add-ons” not a Primary service.

Updated Vaccine CPT Codes | 8/15/19

New and revised vaccination codes available as of July 1, 2019 and January 1, 2020.

Preventing Disease One Vaccine at a Time | 8/15/19

August is Immunization Awareness Month – learn what vaccines are covered.

Health Plans Cover Breast Pumps and Lactation Counseling | 8/1/19

August is Breast Feeding Awareness Month: Help your patients know what’s available!

Correct Coding Edits Coming in August | 7/18/19

Correctly code your diagnoses, procedure codes, and modifiers to ensure reimbursement.

Hospital Readmission Payment Policy Update | 10/11/19

Learn about important appeal information, guidelines, and additional exclusions for hospital readmissions.

Physician and Provider Relations Phone Line Is Available | 6/6/19

Phone line and online resources are available for Physicians and Providers.