July 2020

CMO Perspective

COVID-19 Reveals Health and Economic Inequities Among Latinxs

In last month’s CMO Perspective, our Vice President and Chief Medical Officer, Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, opened a discussion on racial disparities in COVID-19 infection and death rates in Chicago and across Illinois. Preliminary data showed significantly higher infection and death rates among the Black community. More recently, the data has exposed similar disparities among Hispanic Americans, such as residents of Chicago’s Little Village neighborhood on the city’s Southwest Side.

COVID-19 Awareness

Provider Information on COVID-19 Coverage

We appreciate the care you’re providing to our members during the COVID-19 pandemic. With the evolving changes, see these three pages for the most current Blue Cross and Blue Shield of Illinois (BCBSIL) information:

• Provider Information on COVID-19 Coverage
• COVID-19 Related News
• COVID-19 Important Dates and Reminders

Remdesivir Donated to the Federal Program is Ineligible for Separate Reimbursement

BCBSIL continues to provide coverage for medically necessary care for the treatment of COVID-19. The federal government is currently donating remdesivir to facilities for COVID-19 treatment. Facilities receiving donated remdesivir should not separately bill for the product. Remdesivir is considered investigational for the treatment of COVID-19. If providers attempt to seek reimbursement for donated remdesivir, BCBSIL will deny the item as not covered. Other medically necessary treatments associated with hospitalization for COVID-19 will be covered. Read more here.

Help Your Patients Stay Safe from COVID-19 Scams

Criminals are using COVID-19 as a chance to steal identities and commit health care fraud. You may want to encourage your patients to be wary of calls asking for their BCBSIL member ID number or other private information like their Social Security number, date of birth or credit card number.

BCBSIL Has Resources to Help Your Patients During COVID-19

We understand that this may be a stressful time for your patients. That’s why we offer resources you can share to help your patients learn more about topics such as mental and physical health tips, expanded access to care and benefits for COVID-19, frequently asked questions and how to guard against COVID-19 scams and identity theft.

Electronic Options

Use the Availity^® Authorizations Tool for Online Benefit Preauthorization Requests

As a reminder, iExchange^® will be deactivated in the very near future. You are encouraged to transition and use the Availity Authorizations tool for electronic benefit preauthorization requests handled by BCBSIL for inpatient admissions and select outpatient services.

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 required for a particular member/service?

Has your information changed? Let us know!

When seeking health care services, our members often rely upon the information in our online Provider Finder^®. In particular, potential patients may use this online tool to confirm if you or your practice are a contracted in-network provider for their health care benefit plan. Other providers may use the Provider Finder when referring their patients to your practice.

Clinical Updates, Reminders and Related Resources

Refer Our Members to In-Network Laboratories

As a BCBSIL network provider, please refer all laboratory services to participating, in-network providers.

Blue Cross Community Health Plans^SM (BCCHP^SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM Appointment Availability Timeframes

To ensure that BCCHP and MMAI members have timely access to care, appointment standards are specified in your provider agreements.

Pharmacy Program

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2020 – Part 2

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions, revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) were made to the BCBSIL drug lists. Changes effective on or after July 1, 2020, are outlined here.

Avoid National Drug Code (NDC) Billing Mistakes

Submitting claims with the appropriate NDC information may help with claims processing and may help you spend less time troubleshooting a rejected claim line.

Claims and Coding

Reminder: CPT^® Codes May Change

As a reminder, Current Procedural Terminology (CPT) codes may change throughout the year due to changes (new, replaced or removed codes) implemented by the American Medical Association (AMA).

Provider Claims Dispute Process Overview for Government Programs

If you are a provider who is contracted to provide care and services to our BCCHP and/or MMAI Plan members, you’re likely familiar with our provider claims dispute process. For your convenience, we’ve included a reminder overview in this month’s issue.

Provider Education

Quick Tips and Reminders from BCBSIL Provider Network Consultants

Our Provider Network Consultants (PNCs) serve as the liaison between BCBSIL and the independently contracted providers who work with us. Each month, our PNCs host a “Hot Topics” webinar to help keep you up-to-date on important information. Based on feedback from providers, our PNCs would like to share some quick tips and reminders for you and your staff.

Provider Learning Opportunities

BCBSIL offers free webinars and workshops for the independently contracted providers who work with us. A preview of upcoming training sessions is included in this month’s issue.

Notification and Disclosure

Important Dates and Reminders

Check here each month for a quick snapshot of recent implementations, upcoming changes, special events, important deadlines and other reminders.

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