Blue Review - September 2020 | view in Web Browser
A newsletter for contracting institutional and professional providers |
September 2020
Clinical Updates, Reminders and Related Resources
Getting A Flu Vaccine Will Be More Important Than Ever This Year
According to the Centers for Disease Control and Prevention (CDC), it’s likely that flu viruses and the virus that causes COVID-19 will both be spreading this fall and winter. In this context, the CDC says getting a flu vaccine will be more important than ever.
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Resuming Outreach to Medicare Members to Close HEDIS® Gaps
Every year the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage (MA) plans’ performances and scores them in a five-star scale known as the CMS Stars Ratings. This includes Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM plans. Due to COVID-19, CMS made several changes as to how the star ratings are calculated.
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Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM Appointment Availability Timeframes
To ensure that BCCHP and MMAI members have timely access to care, the following appointment standards are specified in your provider agreements.
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CMO Perspective
COVID-19 Sparks HEDIS Changes for Medicaid Pay-for-Performance Measures, Including Telehealth
In this month’s CMO Perspective, our Vice President and Chief Medical Officer, Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, is focused on providing you with information regarding key updates on quality measures, which may be relative to your practice, both in person and by telehealth.
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What’s New
Attend a Free Blue UniversitySM Webinar on Vaccine Confidence
Register today for our free Blue University virtual event for providers titled, Vaccine Confidence: Addressing Concerns of Vaccine-Hesitant Parents.
Blue Door Neighborhood CenterSM Now Open in Chicago’s Morgan Park Neighborhood
We opened our second Blue Door Neighborhood Center (BDNCSM) at 11840 S. Marshfield Ave. in the Morgan Park neighborhood of Chicago.
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We’ve Made Our HMO Scope of Benefits Information Easier to Navigate
Our Provider website includes a set of guidelines for HMO benefit interpretation – the Scope of Benefits. The Scope of Benefits is intended to give each Medical Group/Independent Practice Association (MG/IPA) an overview of covered and non-covered services for quick reference purposes.
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Pharmacy Program
National Prescription Drug Take Back Day is Oct. 24, 2020
Our members look to you for guidance in matters concerning their health, so we need your help spreading the word on safe disposal of prescription medications.
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Electronic Options
Submit Predetermination of Benefits Requests via the Availity® Provider Portal
Blue Cross and Blue Shield of Illinois (BCBSIL) is pleased to introduce an electronic predetermination of benefits request process via the Availity Provider Portal using the new Attachments tool.
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Obtain BCBSIL Patient ID Numbers Online via Availity
Did you know you can get a BCBSIL patient ID number online? We recently added an online tool called Patient ID Finder, located in our BCBSIL-branded Payer Spaces section via the Availity Provider Portal.
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iExchange® Deactivated on Aug. 17, 2020
Our previous electronic benefit preauthorization and predetermination of benefits request tool, iExchange, was deactivated on Aug. 17, 2020.
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Claims and Coding
Illinois Medicaid Claim Filing Tip: Include the Prior Authorization Number
When prior authorization is required, it must be obtained before the service is performed. Prior authorization numbers are assigned by the payer or Utilization Management Organization (UMO) to confirm that necessary review has been completed and benefits have been approved for coverage.
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Provider Education
BCCHP and MMAI Provider Alert: Mandatory Annual Training Must Be Completed by Dec. 31, 2020
It is a CMS and/or Illinois Department of Healthcare and Family Services (HFS) requirement for BCBSIL to make available provider training on specific topics related to MMAI and BCCHP. Annual completion of all required training modules is mandatory for all MMAI and BCCHP contracted providers.
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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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Reminder: Some Specialties Do Not Need Credentialing
As a reminder, some specialists do not require credentialing to be part of the BCBSIL networks.
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Notification and Disclosure
Procedure Code and Fee Schedule Updates
As part of our commitment to informing our independently contracted providers of certain developments, BCBSIL has designated a specific section in the Blue Review to notify you of any significant changes to the physician fee schedules.
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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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an Independent Licensee of the Blue Cross and Blue Shield Association
300 E. Randolph Street, Chicago, IL 60601
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