Blue Review - November 2020 | view in Web Browser
A newsletter for contracting institutional and professional providers |
November 2020
CMO Perspective
Moving from Listening to Action: Thank You for Your Feedback
In this month’s CMO Perspective, our Vice President and Chief Medical Officer, Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, discusses 2020 initiatives that have focused on finding ways to help make it easier for you to do business with us.
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Provider Education
Your Opinion Makes A Difference
The Blue Review is your provider newsletter, published monthly by Blue Cross and Blue Shield of Illinois (BCBSIL). Your feedback helps us improve our newsletter so that you receive timely information that matters to you and your organization. Please take a few minutes to complete our annual Blue Review newsletter readership survey. The survey will be available through Nov. 30, 2020. Don’t miss this opportunity to tell us what you think.
Commercial PPO and BCCHPSM Providers: Join Us for An Orientation Webinar
Our Provider Relations team hosts quarterly orientations for providers who are contracted with BCBSIL to provide care and services to our commercial PPO, Blue Choice PPOSM and/or Blue Cross Community Health PlansSM (BCCHP) members.
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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.
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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 prior authorization required for a particular member/service?
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Updates and Reminders: Submit Predetermination of Benefits Requests via Availity®
On July 30, 2020, BCBSIL implemented an electronic submission process for predetermination of benefits requests via Availity’s Attachments tool. This tool was recently updated to better help you with sending your online requests to BCBSIL.
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What’s New
Submit Electronic Professional and Facility Claims via the Availity Provider Portal
The Availity Provider Portal offers providers a no-cost solution to submit electronic Professional and Institutional claims (ANSI 837P and 837I transactions) to BCBSIL.
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Enhanced Availity Claim Status Tool Replaces Claim Research Tool, Gives You One Tool for All BCBSIL Members
As of Oct. 19, 2020, the Claim Status tool now includes detailed claim status for commercial, Federal Employee Program® (FEP®) and on- and off-exchange members, in addition to Medicare Advantage and Illinois Medicaid members. The Claim Research Tool has been retired.
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View Professional Provider Fee Schedule via Availity – Coming Soon
Fee schedules are a key component of your contractual relationship with BCBSIL. To help ensure you have this information quickly, BCBSIL is implementing a new online Fee Schedule viewer tool via the Availity Provider Portal for participating professional providers in our Preferred Provider Option (PPO) and Blue Choice PPO networks.
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Clinical Updates, Resources and Reminders
Provider Training in December: Commercial Prior Authorization Transition from eviCore to AIM
Starting Jan. 1, 2021, prior authorization requests for commercial BCBSIL members that are currently required to be submitted through eviCore healthcare (eviCore) will require prior authorization through AIM Specialty Health® (AIM).
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New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021
Effective Jan. 1, 2021, some BCBSIL members with group coverage may need prior authorization for certain procedures. This article lists three-character member ID prefixes for those members that may be affected.
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City of Chicago Benefit Change, Effective Jan. 1, 2021
Effective Jan. 1, 2021, there will be a utilization management vendor change for prior authorization of physical therapy services for some City of Chicago employees with BCBSIL coverage.
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Are you using these shared decision-making aids when talking with your patients?
A list of resources is available to help you involve your patients in shared decision making. The evidence-based aids provide information about treatment options, lifestyle changes and outcomes. Read more on our Provider website.
Focus on Behavioral Health
New Tip Sheets for Behavioral Health HEDIS® Measures: FUA and FUM
We’ve added two behavioral health tip sheets to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code claims appropriately. Read more on our Provider website.
Quality Improvement and Reporting
2020 Annual HMO and PPO HEDIS Reports
Each year, BCBSIL reports audited HEDIS results.
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Wellness and Member Education
Free World AIDS Day Event at Blue Door Neighborhood CenterSM
Leading up to World AIDS Day on December 1, our Blue Door Neighborhood Center (BDNCSM) will host virtual HIV/AIDS 101 courses for all community members.
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Childhood Immunization Rates Fall Amidst Pandemic Fears
After the pandemic declaration in March, office visits for immunizations among BCBSIL members significantly dropped between March and May 2020, compared with the number of visits reported by claims data during the same period in 2019.
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Claims and Coding
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) for Medicaid Children
The goal of EPSDT is to ensure children and adolescents under the age of 21, who are enrolled in Medicaid, receive age-appropriate screenings, preventive services and treatments that are medically necessary to avert or diagnose, and treat any health problems as early as possible.
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Itemized Bills Required for Some Facility Claims Over $100k
Beginning Jan. 1, 2021, BCBSIL will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. Read more on our Provider website.
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).
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Notification and Disclosure
Clinical Practice and Preventive Care Guidelines Updated for 2020-2021
Our medical directors and Quality Improvement Committee have updated our Clinical Practice Guidelines and Preventive Care Guidelines for the 2020-2021 year.
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Medical Policy Updates
Approved, new, or revised Blue Cross and Blue Shield of Illinois (BCBSIL) Medical Policies and their effective dates are usually posted on our Provider website the first day of each month.
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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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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 Webinars and Workshops page. |
Quick Reminders
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