July 2022

Provider Education 

Provider Hot Topics Summary: Second Quarter 2022

In case you missed a Provider Hot Topics webinar or two this spring, our Provider Network Consultants (PNCs) have prepared a re-cap. What was the most frequently asked question (and our PNCs’ answer)? Which Blue Review article and News and Updates notice should you go back and read again?

Pricing Information to Display Starting in July

The Transparency in Coverage Final Rule requires health insurers and some employers to publicly display certain health care price information via machine-readable files beginning July 1, 2022. Among other details, these files will include your federal Taxpayer Identification Number (TIN), or your Social Security number, if you’re using your SSN for your TIN.

Provider Learning Opportunities

Blue Cross and Blue Shield of Illinois (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.

What's New

‘CMO Perspective’ Goes Online

You may recall our former CMO Perspective article series in the Blue Review. We’ve transitioned this column to an online blog-style format. We’ll use this forum to feature insights on timely topics from our vice president and chief medical officer, Derek Robinson. Visit the CMO Perspective page to view Dr. Robinson’s first entry from June 24, 2022 – Chronic Kidney Disease: Examining Health Disparities in Communities of Color – which re-caps a panel discussion on the outdated use of race modifiers in determining patient risk and treatment for CKD. Also see Dr. Robinson’s post on July 1, 2022 – Pediatric Vaccines: A Call to Action to Help Protect Illinois Children and Teens.

Clinical Updates, Resources and Reminders

Talk with Your Patents About Managing Diabetes

To help monitor and improve our members’ care, we track quality measures developed by the National Committee for Quality Assurance related to diabetes care. We’ve compiled a list of reminders, tips to consider and resources to share with your patients.

In-home Test Kits for Colorectal Cancer Screening

We’re working with Everlywell to provide in-home colorectal cancer test kits to some of our members this summer. If they receive a kit, our members may ask for your guidance as their trusted provider.

Prior Authorization Code Updates, Effective Oct. 1, 2022 (Commercial and Government Programs)

BCBSIL is changing prior authorization requirements that may apply to some of our commercial non-HMO, Medicare Advantage (PPO) and Illinois Medicaid members. Refer to the News and Updates for the notices that summarize commercial and government programs prior authorization code list updates, effective Oct. 1, 2022.

Pharmacy Program

Pharmacy Program Updates: Prior Authorization (PA) Changes Effective July 15, 2022

The 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 more information on changes effective Aug. 1, 2022, and August and October 2022.

Wellness and Member Education

Catch Up on Routine Vaccines and Well-Child Visits

The COVID-19 pandemic disrupted routine childhood immunizations and well-child visits for many people, according to the Centers for Disease Control and Prevention (CDC). We’ve created Wellness Guidelines and vaccine information for our members to boost awareness.

Help Your Younger Patients Get a Healthy Start

Regular health screenings, immunizations and wellness checkups are critical to help detect health issues early, when they're easier to treat. During July, our Wellness Can't Wait campaign is spotlighting Child and Adolescent Well Care.

Community Involvement

We’re Kicking Off the Summer Season with Community Events at Our Blue Door Neighborhood Center^SM

Summer’s officially here! Our Blue Door Neighborhood Center (BDNC^SM) locations are hosting programs that warm weather wellness. Visitors to our South Lawndale BDNC will learn about protecting their skin, staying hydrated, barbeque safety and more.

Electronic Options

We’re Collecting Telehealth Information for Our Provider Directories

In accordance with Illinois Senate Bill 332, which amends the Illinois Network Adequacy and Transparency Act, we’re required to update our provider directories to show telehealth information for each contracted provider. We’ve started collecting telehealth information from commercial providers in our PPO, HMO, and Blue Choice PPO^SM networks. If you’ve already shared your telehealth information with us, thank you! If not, please refer to the article in our May Blue Review for details, like the fields and definitions you’ll see when using our online forms.

Claims and Coding

BlueCard^® Program Reminder Checklist

Vacation season’s here and, through the BlueCard program, many Blue Cross and Blue Shield (BCBS) members are taking their coverage with them when they travel. See our checklist of important reminder to help you when you’re filing claims for out-of-area BCBS members.

Network Innovation/Product Updates

Flex and Open Access for Medicare Patients and Providers

If you’re a Medicare provider, you may treat Blue Cross Medicare Advantage Flex (PPO)^SM and Blue Cross Group Medicare Advantage Open Access (PPO)^SM members, regardless of your contract or network status with BCBSIL.

Quality Improvement and Reporting

Physician Efficiency, Appropriateness, and Quality^SM (PEAQ^SM) Program:
Provider Questions and Other Resources

We’re preparing to roll out our PEAQ program to Illinois providers soon. Until then, we’ll continue to publish articles in the Blue Review to keep you informed.

Provider Satisfaction Survey 2022

Building a strong network of providers and working with you to serve our members is important to us. To support this effort, we survey a random sample of providers each year. Read more on News and Updates.

Health Care Fraud is Not a Victimless Crime

BCBSIL participates in inquiries and investigations to identify and address potentially fraudulent activities. Our Special Investigations Department (SID) is committed to fighting fraud, reducing health care costs and protecting the integrity of the BCBSIL provider network.

Notification and Disclosure

Medical Policy Updates

Approved, new or revised BCBSIL Medical Policies and their effective dates are usually posted on our Provider website the first day of each month.

Procedure Code and Fee Schedule Updates

As part of our commitment to help inform 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.

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).

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