Blue Review
A newsletter for contracting institutional and professional providers

November 2020

Moving from Listening to Action: Thank You for Your Feedback

By: Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Illinois (BCBSIL)

This year, more than ever before, we appreciate the strength and resilience of the Illinois provider community. The pandemic has been a wakeup call for many, demanding our attention and forcing us to find ways to grow and adapt amidst the chaos and uncertainty of COVID-19. Social distancing, while difficult, has also fostered an attitude of introspection. And at BCBSIL, we’ve used this time to scrutinize what’s not working. Specifically, we are taking a hard look at ways to make it easier for providers to do business with us. You may have responded to a survey, letter or phone call from us. Perhaps you have given feedback during a meeting. Or, you may have reached out to us in other ways to let us know what we can do better. Introspection alone does not guarantee excellence; I want you to know we’ve heard you and we appreciate your comments, insights, and feedback. Your input has informed our action and some important changes, and there are more to come. Here are some highlights:

Expanded Care Management Support
We’ve extended our weekday hours and accelerated proactive outreach to certain members at greatest risk for COVID-19 infection to help address their social and clinical needs. We’ve also doubled the availability of care management team members on the weekends to support providers and members.

Improved Administrative Operations
We’ve enhanced existing online tools and introduced new tools available via the Availity® Provider Portal. Our previous online tool, iExchange®, was retired and the Availity Authorizations and Attachments tools were implemented. These options allow online submission of prior authorization and predetermination requests. You’ll find several articles in this month’s newsletter with details about other electronic options on Availity, such as the enhanced Claim Status tool that was implemented last month, and the Fee Schedule viewer, coming soon.

Interoperability
We’ve launched a new health information platform through Epic to enable two-way exchange of information between BCBSIL and providers who use Epic to review patient data (such as medical records, lab results and claims), conduct electronic transactions, coordinate care management strategies and find potential gaps in care. By improving patient-provider-payer connectivity at the point of service, we can support increased effectiveness of communication to support care delivery for improved health outcomes. View the article in our Newsroom for more information.

Enhanced Provider Communications
Our members, your patients, are top priority. However, we’re also committed to best in class service to providers. We want to be your payer of choice. So, we need to do everything we can to increase communication effectiveness.

  • Provider Website – I’m pleased to announce that we’ve reorganized the former Prior Authorization section of our Provider website. This section, now called Utilization Management, includes the following pages for each type of pre-service medical necessity review: Prior Authorization, Predetermination and Pre-notification. Each page defines terminology along with steps to assess if review is needed and how to request it. The Utilization Management section also includes Support Materials for Commercial and Government Programs, such as prior authorization procedure code lists for reference purposes. We’ll continue to refine and enhance this section of our website to ensure the information is useful.
  • Medical Director Tutorial – Also related to utilization management, we're offering educational resources to help clarify any questions or concerns you may have. Our team of medical directors is using their insight and expertise to develop an online informational reference guide, using a peer-to-peer approach, to help increase awareness, transparency and engagement. Watch our News and Updates for announcements in the coming months – we’ll let you know when new educational resources are added to the Utilization Management section of our website.
  • Blue Review – I look forward to continuing to connect with you via the CMO Perspective each month. To make this communication platform valuable and informative with topics and content that’s important to you, I encourage you to share your opinion. Please take a few moments to complete our readership survey – it’s open through the end of this month. This is your chance to let us know what works and what doesn’t. As always, you can also email our editorial staff with any feedback.

It’s our goal to provide you exemplary support. To that end, we'll continue to evaluate and reassess our offerings and services and identify opportunities for improvement. For that to be most effective, we need your feedback so please continue to let us know what more we can do to support you and enhance our partnership. Undoubtedly, we’ve all been challenged by the pandemic but in these unparalleled times, I believe there are opportunities for collaboration and convening of new ideas and processes that can help you and our health care community.

Learn more about Dr. Derek J. Robinson

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Please note that the fact that prior authorization has been obtaining is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, contact the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. iExchange is a trademark of Medecision, Inc. (Medecision), a separate company that provides collaborative health care management solutions for payers and providers. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.