August 2022

Electronic Options 

New Online Option to Confirm Medical Record Receipt Status

You don’t need to call Blue Cross and Blue Shield of Illinois (BCBSIL) to confirm receipt of medical records you’ve mailed or faxed to us for claim processing. We’ve launched a new application in the BCBSIL-branded Payer Spaces section via Availity^® Essentials so you can verify medical record receipt online. 

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? 

Pharmacy Program  

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2022 – Part 2

On May 11, 2022, we posted a July Quarterly Pharmacy Changes Part 1 article in News and Updates. It includes important reminders, drug list changes, dispensing limit changes and utilization management program changes. For a follow-up with additional 3rd quarter changes, see the News and Updates for the July Quarterly Pharmacy Changes Part 2 article, posted July 19, 2022.

Pharmacy Program Updates: Prior Authorization Changes Effective October 2022

The Pharmacy Prior Authorization (PA) program encourages safe, cost‑effective medication use by allowing coverage when certain conditions are met. A clinical team of physicians and pharmacists develops and approves the clinical programs and criteria for medications that are appropriate for PA by reviewing U.S. Food and Drug Administration (FDA) approved labeling, scientific literature and nationally recognized guidelines. See the News and Updates for pharmacy PA changes effective Oct. 1, 2022.

Wellness and Member Education

Share Facts About Immunizations With Your Patients in August

According to the American Academy of Pediatrics, immunizations are one of the greatest public health achievements, preventing tens of thousands of deaths and millions of cases of disease, while avoiding billions of dollars in costs.

Community Involvement

2022 Back to School Events at Our Blue Door Neighborhood Center^SM Locations

As “back to school” sales remind us of the end of summer, BCBSIL is working with the Chicago Department of Public Health on a series of free vaccination clinics for the whole family. Clinics will take place at all Blue Door Neighborhood Center (BDNC^SM) locations.

Focus on Behavioral Health

Behavioral Health Support Resources: Maternity Program for Blue Cross Community Health Plans^SM (BCCHP^SM) Members

Many BCBSIL members – including BCCHP members – have access to our Special Beginnings^® maternity program. This program is offered for members in early pregnancy until 84 days after giving birth. It can help members better understand and manage their health during pregnancy.

Provider Education

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.

Has your information changed? Let us know!

When seeking health care services, our members often rely upon the information in our online Provider Finder^®. Prospective patients can use this online tool to confirm if your practice is a contracted in-network provider for their health care benefit plan.

Claims and Coding

New Laboratory Management Program to Begin Nov. 1, 2022 

You may have seen the communication about the delayed launch of our new Laboratory Benefit Management program with Avalon Health Solutions. We delayed this launch to continue providing education and clarity to providers about the program. Effective Nov. 1, 2022, BCBSIL will implement its new program with Avalon Healthcare Solutions for claims for certain outpatient laboratory services provided to many of our commercial, non-HMO members. Read more on News and Updates.

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). 

Claims and Coding

Reviews on Inpatient DRG Claims for BlueCard^® (Out of Area) Medicare Advantage Members

The Blue Cross and Blue Shield Association requires all host Blue Cross and Blue Shield (BCBS) Plans to review select inpatient, diagnosis-related group (DRG) claims for any out-of-area Blue Cross Medicare Advantage^SM members. Beginning Oct. 15, 2022, BCBSIL will work with EXL Health (EXL) to complete these reviews. The review will check for compliance with ICD-10 procedure coding system guidelines. Read more on News and Updates.

Illinois Medicaid Providers: Confirm Certifications and Licensure are Active in the IMPACT System

If you’re attested with the Illinois Department of Healthcare and Family Services (HFS) to provide care and services to Illinois Medicaid members, you must confirm your certification or licensure on file in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system is current. This is a condition of participation in the Medicaid program. Read more on News and Updates.

Clinical Updates, Resources and Reminders

Medicaid Reminder: HFS Reinstatement of Certificate of Transportation Services (CTS) Form, Effective June 1, 2022

In April 2022, the Illinois Department of Healthcare and Family Services (HFS) issued this provider notice to announce the new date for reinstatement of the HFS 2271 Certification of Transportation Services (CTS) form. As specified in the notice, the HFS 2271 form is to be used for all non-emergency transports originating at a patient’s private residence for dates of service on or after June 1, 2022. Read more on News and Updates.

Use Our New Prior Authorization Digital Lookup Tool for Medicaid Member Information

You may be familiar with some of the Medicaid prior authorization resources on our Provider website. These include prior authorization code lists with effective dates and related information for BCCHP and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM members. Recently, we added a digital lookup tool that gives you a different way to view prior authorization requirements that may apply to our BCCHP and MMAI members. 

Quality Improvement and Reporting

Blue Distinction^® Centers for Cancer Care

The Blue Distinction Centers for Cancer Care program aims to improve patient outcomes and cost by addressing fragmented delivery of care. It’s available for all cancer types and various care settings, including physician groups, cancer centers, hospitals and accountable care organizations (ACOs).

Blue Review Readership Survey: Your Ideas and Input in Action 

We’re grateful to all providers who took the time to respond to our annual year-end Blue Review readership survey. Before we move forward with this year’s survey, we wanted to share our “report card” – how we performed and what we’ve been doing to improve, based on your ratings and feedback.

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