Blue Review - February 2019 | view in Web Browser
A newsletter for contracting institutional and professional providers |
February 2019
CMO Perspective
Quality Improvement Priorities for 2019: Focus on the HMO Model
Our Vice President and Chief Medical Officer, Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, opens a discussion on quality measurement, with an emphasis on several priorities in the areas of cardiovascular care, cancer screening, chronic obstructive pulmonary disease management and health equity.
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Focus on Behavioral Health
Behavioral Health Providers: We Need Your Help to Improve Access to Care
The need for behavioral health care continues to rise in Illinois. Blue Cross and Blue Shield of Illinois (BCBSIL) is trying to make it easier for our members to know where to go for help. We are conducting a survey through March 1, 2019, to gather more details about behavioral health care providers. This information will be used to update our online Provider Finder®.
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Wellness and Member Education
Encourage Patients to Enter Faces of FearlessSM Contest
Do you have a patient who is working hard to overcome an illness or injury? One that you find inspirational and determined to live their healthiest life possible?
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Pharmacy Program
New Opioid Drug Management Program for Medicare Members
On Jan. 1, 2019, BCBSIL implemented a new opioid drug management program to promote the safe and effective use of prescription opioids for our Medicare Part D members who have prescription drug benefits administered through Prime Therapeutics.
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Provider Education
Attend a Blue UniversitySM Follow-up Webinar on February 15
In 2018, BCBSIL along with national and local thought leaders gathered at the Blue University events in Chicago to learn more about current health care trends, best practices and emerging challenges, through expert speakers and collaborative learning. Join a follow-up webinar.
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Provider Learning Opportunities
BCBSIL provides free educational workshops and webinars with an emphasis on electronic transactions, provider tools and helpful online resources. A list of upcoming training sessions is included in this month’s issue.
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Clinical Updates, Reminders and Resources
Radiology Quality Initiative (RQI) Program is Business as Usual
As a reminder, AIM Specialty Health® (AIM) administers the RQI Program for BCBSIL for most groups. An RQI number must be obtained through AIM prior to ordering CT/CTA scans, MRI/MRA scans, Nuclear Cardiology studies, and PET scans for most PPO members.
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Why Doctors Review Health Insurance Claims
A recent article in our online magazine explains how experienced physicians work within our company to offer peer-level review of certain benefit preauthorization requests and claims.
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Claims and Coding
Illinois Medicaid: Encounter Compliant Claim Submission Requirements and BCBSIL Edits
In order to help supply complete and accurate data to the Illinois Department of Healthcare and Family Services (HFS), BCBSIL is implementing compliance edits for Blue Cross Community Health PlansSM (BCCHPSM) claims. BCBSIL has had a version of these edits in place since August 2016 for BCCHP claims.
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Electronic Options
Leverage the Availity® Provider Portal for Efficiencies and Cost Savings
BCBSIL offers free online training to help you and your staff learn more about existing and new tools on the Availity Portal. Don’t miss our special in-depth webinar this month on Availity’s Medical Attachments application for quality and risk adjustment, Claim Encounter Reconciliation Application (CERA) and the Clinical Quality Validation (CQV) tool.
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Quality Improvement and Reporting
Information about BCBSIL’s Quality Improvement Program
The Quality Improvement (QI) Program at BCBSIL addresses both care and services provided to members. A QI Program summary is available upon request if you would like more information about BCBSIL’s QI Program.
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Notification and Disclosure
Medical Policy Updates
Approved, new, or revised BCBSIL Medical Policies and their effective dates are usually posted on our Provider website the first day of each month. These policies may impact your reimbursement and your patients’ benefits.
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ClaimsXtenTM Quarterly Updates
New and revised Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are periodically added to, or deleted from, the ClaimsXten code auditing tool software by the software vendor.
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Stay informed! Watch the News and Updates on our Provider website for important announcements. Update Your Information Do you need to update your location, phone number, email or other important details on file with BCBSIL? Use our online forms to request an information change. Provider Training For dates, times and online registration, visit the Workshops/Webinars page. Online Magazine You and your patients also may be interested in viewing the latest stories on our Making the Health Care System Work site. |
Quick Reminders
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an Independent Licensee of the Blue Cross and Blue Shield Association
300 E. Randolph Street, Chicago, IL 60601
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