Blue Review
A Provider Publication

April 2022

Closing Gaps in Colon Care

Screening is the most effective way to reduce the risk of colorectal cancer, according to the Centers for Disease Control and Prevention (CDC). The CDC and the U.S. Preventive Services Task Force (USPSTF) recommend that everyone 45 to 75 years old get a screening. We encourage you to discuss screening and colon health with our members. We’ve created resources that may help.

Recommended Screening
USPSTF recommends screening with any of the following tests for adults ages 45 to 75:

  • Annual guaiac fecal occult blood test (gFOBT)
  • Annual fecal immunochemical testing (FIT)
  • DNA-FIT every one to three years
  • Flexible sigmoidoscopy every five years
  • Flexible sigmoidoscopy every 10 years with annual FIT
  • Computed tomography (CT) colonography every five years
  • Colonoscopy every 10 years

Providers may want to discuss earlier screening with members with a family history of colorectal disease or other risk factors. See our preventive care guidelines for more information about screening.

Closing Care Gaps
Colorectal Cancer Screening is a quality measure developed by the National Committee for Quality Assurance (NCQA) that tracks appropriate screenings. We track data from quality measures to help assess and improve our members’ care. To help close gaps in care, consider these tips:

  • In our members’ records, document the date a colorectal cancer screening is performed or include the pathology report indicating the type and date of screening.
  • Encourage members to stay up to date on screening.
  • Reach out to members who cancel screenings and help them reschedule.

Checking Eligibility and Benefits
For most of our members, preventive colorectal cancer screening is covered at no cost share. Testing that doesn’t fall under preventive care guidelines, such as having a family history or additional risk factors, may impact the member’s cost share. Check member eligibility and benefits using Availity® Essentials or your preferred vendor before every scheduled appointment. Eligibility and benefit quotes include members’ coverage status and other important information, such as applicable copays, coinsurance and deductibles.

Some screenings involve a member’s pharmacy benefits in addition to their medical benefits, such as the prep kit for colonoscopies. For details about pharmacy benefit coverage, call the number on the member’s ID card. A member’s pharmacy benefit may be managed by a company other than Blue Cross and Blue Shield of Illinois (BCBSIL).