January 2019

CMO Perspective

Let’s Work Together in 2019 to Help Reduce Health Care Disparities

Our Vice President and Chief Medical Officer, Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, kicks off the new year with a discussion of some of our company’s priorities for 2019.

Clinical Updates, Reminders and Resources

Notification of Annual Benefit Updates

As a reminder, Blue Cross and Blue Shield of Illinois (BCBSIL) will be updating member files with annual benefit changes over the next few weeks. Updates are also in progress due to open enrollment. We encourage all providers to use electronic options rather than calling BCBSIL for eligibility and benefits requests.

Annual Reminder: Medicare Outpatient Observation Notice Required

As of March 8, 2017, hospitals and Critical Access Hospitals (CAH) must give the standardized Medicare Outpatient Observation Notice (MOON) to people who receive Medicare benefits and are observed as outpatients for more than 24 hours. For BCBSIL, this includes our Blue Cross Medicare Advantage (PPO)^SM, Blue Cross Medicare Advantage (HMO)^SM and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM members.

Electronic Options

Check Eligibility and Benefits: Don’t skip this important first step!

Is your patient’s membership with BCBSIL still active? Are you or your practice/medical group in- or out-of-network for a specific patient? Is benefit preauthorization/pre-notification required for a particular member/service?

Close HEDIS^® Gaps Easily Through the Availity^® Provider Portal

You may now quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS) measures using Availity’s new Clinical Quality Validation (CQV). CQV will allow providers to electronically document their patient’s care and assessments to close quality HEDIS gaps for BCBSIL members.

Responding to Electronic Quality and Risk Adjustment Medical Record Requests Via the Availity Provider Portal

We want to help make it easier for providers to do business with us. Coming soon, you will be able to receive electronic quality and risk adjustment medical record requests from BCBSIL and submit the needed documentation through the Availity Portal.

Tips to Help You Navigate Our New Provider Onboarding Form

BCBSIL welcomes you to apply to join our provider networks. Our new Provider Onboarding Form is designed to help streamline the application process and possibly expedite the response time. Here are some tips to help you when you are using the online form.

Focus on Behavioral Health

Behavioral Health Benefit Preauthorizations for City of Chicago Employees

BCBSIL’s Provider Relations team is committed to helping you stay aware of changes and trends that may have an impact on your business. The City of Chicago (three-character member ID prefix: CTY) has implemented changes for employees who are BCBSIL members that affect outpatient behavioral health and outpatient substance abuse services.

Automated Phone System Change for Behavioral Health Services

Checking eligibility and benefits electronically through the Availity Portal or your preferred web vendor is the quickest way to access behavioral health coverage information for BCBSIL members. If you do not have access to electronic options, please be aware of upcoming changes to how eligibility and benefits requests for behavioral health services may be conducted using our automated phone system.

Behavioral Health Forms Get a Facelift

Starting Jan. 1, 2019, you may notice some changes to BCBSIL behavioral health request forms. The changes will help make it easier for you to navigate the forms. The forms also include the new Current Procedural Terminology (CPT^®) codes for Applied Behavioral Analysis (ABA).

Wellness and Member Education

Remind Your Patients: It’s Not Too Late for a Flu Shot

The Centers for Disease Control and Prevention (CDC) reports that for the week ending Dec. 22, 2018, the proportion of people seeing their health care provider for influenza-like illness (ILI) was above the national baseline. 

Help Your Patients Understand Blood Pressure Results

Your patients may not be aware that high blood pressure increases the risk for heart disease and stroke, two of the leading causes of death for Americans. With your continued help, we can work together to help improve member education regarding blood pressure control and blood pressure readings.

Health of America Report Shows Branded Prescription Drug Costs Increased

Drug costs are on the rise, and while many Americans have turned to generic prescription drugs to lower costs overall, prescription drug spending is up. The most recent Blue Cross Blue Shield Association (BCBSA) Health of America Report found reasons for increased drug spending.

Pharmacy Program

Change in Preferred Diabetic Testing Supplies for Select Illinois Medicaid Members

Beginning Jan. 1, 2019, OneTouch^® diabetic testing supply products will become preferred products for BCBSIL members with Blue Cross Community Health Plans^SM (BCCHP^SM) prescription drug coverage.

Network Innovation

Blue Distinction^® Centers for Fertility Care

Blue Distinction is a national designation awarded by BCBSIL in partnership with BCBSA to recognize PPO providers that demonstrate expertise in delivering quality specialty care – safely, effectively and cost-efficiently. The foundation of Blue Distinction Specialty Care is the quality-focused Blue Distinction Center designation.

What’s New

New Professional Provider Network Relations Phone Number

The fastest way to work with us is online, using electronic options listed on the Provider Tools page. But, if you have questions that can’t be answered through online options, call our new phone line.

Provider Education

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.

Quality Improvement and Reporting

HEDIS Results for Medicaid Childhood and Adolescent Immunization

According to the 2018 HEDIS rates for BCCHP and MMAI members, the childhood immunization measure, Combo 10, is improving but fell short of the 75th percentile goal. The adolescent immunization measure, Combo 2, met the benchmark; however, we did not meet the benchmark for Combo 1.

2019 CAHPS Survey for Medicaid Members

BCBSIL conducts an annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey with its BCCHP and MMAI members. The primary focus of the survey is to assess our members’ satisfaction with BCBSIL and its independently contracted providers and specialists.

Notification and Disclosure

Federal Employee Program^® (FEP^®) Introduces FEP Blue Focus

Starting Jan. 1, 2019, you may begin seeing BCBSIL FEP members with FEP Blue Focus, a new benefit plan consistent with our commitment to expand access and make health care more affordable. We will also continue to offer FEP members our Standard Option and Basic Option products.

ClaimsXten^TM 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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an Independent Licensee of the Blue Cross and Blue Shield Association

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