付款人政策记分卡

Payer policy scorecards were created to evaluate how effective payer policies are at establishing appropriate coverage for diagnostic sleep testing services. The intent of the scorecards is to encourage insurers to adopt evidence-based policies that support patient safety and delivery of high-quality care.

The following scorecards for several major payers are based on the careful review of their policies by the AASM Payer Policy Review Committee, and were sent to each payer in advance for comment before posting online.

Diagnostic Testing for Obstructive Sleep Apnea

The AASM Payer Policy Review Committee based the Diagnostic Testing for Obstructive Sleep Apnea (OSA) scorecard on the AASM’s2017 clinical practice guideline on diagnostic testing for OSA。The scorecard’s nine criteria correspond to the clinical practice recommendations contained in the guideline. The Committee also developed a模板政策, intended to serve as an additional resource, which exemplifies a policy that is in alignment with the AASM guideline on Diagnostic Testing for adult OSA.

Click这里访问主动权的初步分析Addressing Gaps Between Payer Policies and AASM Clinical Practice Guidelines Using Scorecards, published in the May 2020 issue of the临床睡眠医学杂志。

鼓励ASASM成员通过对OSA的诊断测试发送与诊断测试相关的付款人coding@www.docksidequiltgallery.com.。

积极的政策

Aetna.

梗阻性睡眠呼吸暂停在成人中

Effective 12/17/2020 –88％
有效07/08/2020 -88％
有效02/18/2020 -88％
有效03/15/2019 -88％
有效10/17/2018 -88％
有效05/15/2017 -83％

AIM专业健康

睡眠障碍管理 - 诊断和治疗管理

Effective 08/16/2020 –54％
有效02/09/2020 -54％
有效03/09/2019 -46%

由马萨诸塞州的Premera蓝色十字架，蓝色十字架蓝盾和独立蓝

蓝色的Cross Blue Shield Federal Employee Program

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

有效10/01/2020 -85％
有效10/01/2019 -85％
有效04/15/2017 -56％

蓝色的Cross Blue Shield of Florida

Sleep Testing

有效09/15/2019 -90％
有效10/15/2018 -90％
Effective 12/15/2016 –69%

Bluecross Blueshield堪萨斯

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

有效06/21/2021 -76％
Effective 01/01/2020 –74％

蓝色的Cross Blue Shield of Michigan and Blue Care Network

Sleep Disorders, Diagnosis and Medical Management

Effective 01/01/2020 –92％
Effective 07/01/2018 –63％
有效08/01/2016 -54％

蒙大拿州的蓝色十字架蓝色盾

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

有效01/01/2019 -73％

蓝色的Cross Blue Shield of New Mexico

Diagnosis and Medical Management of OSA Syndrome

有效01/01/2019 -66％

北卡罗来纳州的Bluecross Blueshield

睡眠呼吸暂停：诊断和医疗管理

有效08/01/2020 -90％
有效08/01/2019 -92％
有效01/01/2019 -86％
有效08/01/2017 -86％

蓝色的Cross Blue Shield of North Dakota

成人阻塞性睡眠呼吸暂停的诊断和治疗

有效03/01/2021 -84％

蓝色的Cross Blue Shield of Wyoming

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

有效06/30/2018 -81％
有效06/01/2017 -81％

蓝色的Shield of California

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

Effective 09/01/2020 –78％
Effective 03/01/2020 –78％
Effective 03/01/2020 –90％
Effective 10/01/2017 –63％

资本布鲁斯

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

Effective 04/01/2021 –80％
Effective 09/01/2020 –79％
Effective 02/01/2020 –78％

Carefirst Bluecross Blueshield.

Sleep Disorders

有效11/18/2019 -80％
有效10/15/2018 -80％
有效02/20/2018 -76％

Cigna

Effective 06/15/2020 –80％
有效06/15/2019 -82％
生效11/15/2016 -62％

Connecticare.

阻塞性睡眠呼吸暂停诊断和治疗

有效02/14/2020 -58%

会徽健康

阻塞性睡眠呼吸暂停诊断和治疗

有效02/14/2020 -47%

Evicore.

有效02/14/2020 -91％
有效02/15/2019 -90％
有效05/17/2018 -87％
有效06/05/2017 -73％

由明尼苏达州的蓝色十字架蓝色盾牌用途和亚利桑那州的蓝色十字架蓝盾

景角健康计划

Polysomnography and Sleep Studies

Effective 03/2018 –67％

宾夕法尼亚州的高标记蓝色十字架蓝盾

Diagnosis and Treatment of Obstructive Sleep Apnea for Adults

Effective 12/16/2019 –57%
有效07/31/2017 -51％

Horizon Blue Cross Blue Shield of New Jersey

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

Effective 07/14/2020 –85％
生效12/10/2019 -87％
Effective 05/01/2019 –90％

人类

睡眠研究，成人

有效08/07/2020 -62％
有效06/25/2019 -71％
有效05/25/2017 -72％

National Imaging Associates, Inc.

Nocturnal PolysomNography和家庭睡眠测试（2个政策）

由哈佛朝圣者使用

Effective 01/01/2020 –88％

优先健康

阻塞性睡眠呼吸暂停包括UPPP和Laup

Effective 08/20/2020 –56％
有效05/27/2020 -54％
Effective 07/01/2019 –54％
有效02/01/2017 -53％

QualChoice.

阻塞性睡眠呼吸暂停

Effective 11/30/2020 –44％

UHC牛津

参加睡眠障碍评估的多乐饰

Effective 09/01/2020 –69%

联合医疗保健

参加睡眠障碍评估的多乐饰

Effective 04/01/2020 –63％
Effective 12/01/2017 –63％
有效08/01/2017 -40％

退休政策

亚利桑那的蓝色横向蓝色盾

阻塞性睡眠呼吸暂停综合征的诊断和医学管理

*退休 - 推迟Evicore.

有效08/01/2017 -71％

马萨诸塞州的蓝色十字架蓝盾*

Polysomnography and Home Sleep Testing

*退休 - 推迟AIM专业健康

有效07/14/2014 -43％

蓝色的Cross and Blue Shield of Minnesota*

Sleep Disorder Testing in Adults

*退休 - 推迟Evicore.

有效07/03/2017 -59%

excellus蓝色十字架蓝盾

睡眠研究

生效10/20/20-62％

Harvard Pilgrim*

有效12/03/2018 -79％
有效09/01/2017 -79％

*退休 - 推迟National Imaging Associates, Inc.

Independence Blue

Sleep Disorder Testing and Positive Airway Pressure Therapy

*退休 - 推迟AIM专业健康

Effective 10/14/2016 –40％

Premera Blue Cross

Polysomnography and Home Sleep Study for Diagnosis of Obstructive Sleep Apnea

*退休 - 推迟AIM专业健康

有效03/01/2017 -76％