Blue Review - February 2022 | view in Web Browser
A Provider Publication |
February 2022
Provider Education
It’s Time: Verify Your Directory Details
In October 2021, we told you about the Consolidated Appropriations Act (CAA) requirement that certain provider directory information must be verified every 90 days. This requirement became effective Jan. 1, 2022.
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BCBSIL Needs Your Help To Update Your Telehealth Information
Another directory update is specified in Illinois Senate Bill 332, which amends the Network Adequacy and Transparency Act. Blue Cross and Blue Shield of Illinois (BCBSIL) is required to update our printed directory and our online provider directory, Provider Finder®, with each contracted provider's telehealth information.
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Reminder: 2022 Claim Editing Enhancements
As we recently announced, BCBSIL will enhance our claims editing and review process with Cotiviti, INC., for some of our commercial members to help ensure accurate coding of services and that services are properly reimbursed.
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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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Claims and Coding
Updated: Surprise Billing Provisions of No Surprises Act
The No Surprises Act (NSA) is a requirement of the CAA for plan years on or after Jan. 1, 2022. It prohibits most out-of-network providers from balance billing patients for certain services. On Jan. 18, 2022, we posted an updated notice that includes information on how to request a claim review. Read more on News and Updates.
EXL Health Is Reviewing Complex Claims
EXL Health is conducting post-payment reviews of complex claims from providers and facilities on behalf of BCBSIL.
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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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What's New
Free Heart Health Month and Black History Month Events at Blue Door Neighborhood CenterSM (BDNCSM)
You and your patients are invited to free, virtual and in-person events celebrating Black History Month and acknowledging Heart Health Month at our three BDNC locations. Check the BDNC calendars for a full list of events.
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Wellness and Member Education
Delivering Quality Care: Supporting Healthy Hearts
Heart disease and stroke are among the leading causes of death in the U.S., according to the Centers for Disease Control and Prevention (CDC). We encourage you to talk with our members, especially during February – American Heart Month – about reducing and managing risks.
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Pharmacy Program
New Specialty Pharmacy for Pharmacy Members
A new specialty pharmacy service provider has been chosen by BCBSIL through our pharmacy benefit manager (PBM), Prime Therapeutics LLC (Prime).
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New Mail Order Service Provider for Pharmacy Members
BCBSIL has chosen a new mail order service provider for our members whose pharmacy benefits are administered through Prime.
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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 2
Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions, revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) were made to the BCBSIL drug lists. Changes effective on or after Jan. 1, 2022, are outlined here.
Quality Improvement and Reporting
Member Experience Surveys (CAHPS® and EES): We All Play a Role
Every year, some BCBSIL members receive surveys to collect information about their experiences with both their health care providers and health insurance plans.
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Notification and Disclosure
ClaimsXten™ Quarterly Update Reminder
The ClaimsXten code auditing tool is updated quarterly. On or after April 11, 2022, BCBSIL will implement the first quarter code update in the ClaimsXten tool.
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Stay informed! Watch the News and Updates on our Provider website for important announcements. Verify and Update Your Information Verify your directory information every 90 days. Use the Availity® Provider Data Management feature or our Demographic Change Form. Facilities may only use the Demographic Change Form. Provider Training For dates, times and online registration, visit the Webinars and Workshops page. |
Quick Reminders
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Contact Us
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