Blue Review - November 2022 | view in Web Browser |
|||
![]() |
|||
|
|||
November 2022 |
|||
|
|||
|
|||
|
Read More |
Addressing Disparities in Breast Cancer for Black Women
October was Breast Cancer Awareness Month, but we want to keep the momentum going. Breast cancer is one of the most common cancers among women in the U.S. and, according to the American Cancer Society, it disproportionately affects Black women. What can you do to help? Read more on News and Updates.
MMAI and BCCHPSM Providers: Join Our Community Stakeholder Committee
We’re hosting quarterly Community Stakeholder Committee meetings to find ways to better serve our Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Community Health PlansSM (BCCHP) members. Register now for the fourth quarter meeting on Dec. 1, 2022.
Read More |
National Diabetes Awareness Month events at Blue Door Neighborhood CenterSM
Our Blue Door Neighborhood Center (BDNCSM) locations will be hosting virtual and in-person National Diabetes Awareness Month events in November.
Read More |
BCBSIL Helps Some Rural Members Prevent or Manage Diabetes
In recognition of Diabetes Awareness Month is in November, we’re getting the word out to our members, especially regarding prediabetes. Our members’ wellness can’t wait.
Read More |
Diabetes Screening for People Using Antipsychotic Medications
People with serious mental illness who use antipsychotic medications are at increased risk of diabetes, according to the National Committee for Quality Assurance (NCQA). Regular screening for diabetes is important for detecting, monitoring and in the treatment of the disease.
Read More |
Pathways to Success: New Medicaid Initiative To Begin Jan. 1, 2023
You may have participated in the recent Illinois Medicaid webinars, facilitated by the Illinois Department of Healthcare and Family Services (HFS), regarding the rollout of the new Pathways to Success initiative. BCBSIL will implement Pathways to Success for our BCCHP members beginning Jan. 1, 2023.
Read More |
Critical Incident Reporting Guidance
Mandated reporting makes specific professionals required by law to report all suspected abuse, neglect and exploitation of children, disabled adults or senior citizens to the appropriate referral entity. Mandated reporters include, but are not limited to: Daycare workers, social workers, law enforcement, teachers, homemaker and adult day care providers, nurses and doctors.
Read More |
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.
Read More |
Illinois Medicaid Claims Alert: Hospice Room and Board Adjustments and Repayment
On Aug. 29, 2022, HFS issued a provider notice regarding incorrect submission of hospice room and board claims to HFS, as these claims should be submitted to the appropriate Managed Care Organizations (MCOs). In response to this notice, BCBSIL will work with hospice providers to resolve claims submission and reimbursement discrepancies, if applicable, for services rendered to BCCHP members. Read more on News and Updates.
New Laboratory Benefit Management Program: Revised Effective Date for Some Policies
Our new program with Avalon Healthcare Solutions for claims for certain outpatient laboratory services provided to many of our commercial, non-HMO members became effective Nov. 1, 2022. Previously, we alerted you that Clinical Payment and Coding Policies (CPCPs) related to certain laboratory services, tests and procedures would be implemented using a phased approach.
Read More |
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).
Read More |
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?
Read More |
Confirm Receipt Status Online for Prior Authorization Medical Records Sent via Fax or Mail
We’ve enhanced our Medical Record Status Viewer so you can use it to confirm receipt of medical records submitted by fax or mail to BCBSIL for commercial prior authorization medical record requests.
Read More |
Prior Authorization Requirement Changes for Some Commercial Members and Code Updates Effective Jan. 1, 2023
BCBSIL is changing prior authorization requirements that may apply to some commercial non-HMO members. Changes are based on updates from Utilization Management prior authorization assessment, CPT code changes released by the AMA or Healthcare Common Procedure Coding System (HCPCS) code changes from the Centers for Medicaid & Medicare Services (CMS).
Read More |
Prior Authorization Requirement Changes for Some Government Programs Members and Code Updates Effective Jan. 1, 2023
BCBSIL is changing prior authorization requirements for Blue Cross Medicare Advantage (PPO)SM (MA PPO), BCCHP and MMAI members. See the article in this month’s issue for a summary of code changes in certain care categories.
Read More |
Postponed: Use Our Automated Phone System to Request Prior Authorization for FEP® Members
In August 2022, we announced the launch of a new feature to offer prior authorization for Federal Employee Program® (FEP) members through our interactive voice response (IVR) phone system. On Oct. 11, 2022, we alerted you that this new feature has been postponed. Please continue to watch the News and Updates for future program announcements.
Pharmacy Program Updates: Prior Authorization (PA) Changes Effective December 2022
The pharmacy 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. Read more on News and Updates.
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 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 Oct. 1, 2022, are outlined here.
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.
Read More |
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. |
|
|
Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
300 E. Randolph Street, Chicago, IL 60601
© Copyright 2022 Health Care Service Corporation. All Rights Reserved.