Supporting Quality Care During Breast Cancer Awareness Month

October is Breast Cancer Awareness Month and a good time to remind our members about the importance of regular screenings for women. We’ve created resources that may help.

Talk to Your Patients About the Flu Vaccine

The Centers for Disease Control and Prevention estimates that from Oct. 1, 2022, through April 30, 2023, there were 27 to 54 million flu illnesses, 12 to 26 million flu medical visits, 300,000 to 650,000 flu hospitalizations and 19,000 to 58,000 flu deaths in the U.S.

Illinois Medicaid Provider Alert: Help Your Patients Get Ready for Redetermination

Some of your patients could lose their Illinois Medicaid benefits if they don’t complete their redetermination paperwork on time. You can help by reminding your patients to update their information and watch for a letter from the Illinois Department of Healthcare and Family Services. See what you can do to help.

Help Close Gaps in Care for Group Medicare Advantage Members: Medical Records and Vendor Reminders

If we need medical records for Blue Cross Group Medicare Advantage (PPO)^SM members, you’ll receive requests from Blue Cross and Blue Shield of Illinois (BCBSIL) or our vendor, Change Healthcare, as part of the Blue Cross and Blue Shield National Coordination of Care program. Please respond quickly to our requests, including requests related to risk adjustment gaps and Healthcare Effectiveness Data and Information Set (HEDIS^®) measures.

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.

Blue Review Readership Survey 2023: Your Voice Matters

As we move into the final months of 2023, it’s time to check in with our readers once again. Does the Blue Review provide content that’s timely, easy to navigate and relevant to the needs of your practice?

BlueApprovR^SM Now Accepts Recommended Clinical Review (Predetermination) Requests – Attend a Training

BCBSIL continues to streamline the pre-service review process to reduce your workload with BlueApprovR. This tool, accessible in Availity^® Essentials, now processes optional recommended clinical review requests – formerly called predetermination requests – for some medical and surgical and specialty pharmacy drugs for many of our commercial, non-HMO members.

Select Medication List To Be Discontinued

Effective Dec. 1, 2023, the Select Medication List will be removed from our Provider website. The Select Medication List included specific medications eligible for increased reimbursement over similar medications within the same drug class, when billed with the appropriate National Drug Code pricing information. This pricing differential will be discontinued on Dec. 1, 2023. Read more on News and Updates.

Reminder Regarding Billing for Point-of-Use Convenience Kits

BCBSIL regularly reviews claims submitted by providers to help make sure benefits provided are for services included in our member’s benefit plan and meet our guidelines.

Pharmacy Program Updates: Prior Authorization Changes Effective Nov. 1, 2023

The BCBSIL 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 approved labeling, scientific literature, and nationally recognized guidelines. Read more on News and Updates.

Itemized Bills Required for Some Facility Claims Over $100K

Beginning Jan. 1, 2024, BCBSIL will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. This applies to facility claims billed at $100,000 or more, or as required by the member’s benefit plan, submitted for some BCBSIL commercial members.*

New Mailing Address for Paper Commercial Claims

We’re updating our P.O. Box for paper claims to help expedite claims processing. Remember, electronic claim submission is preferred.

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. Other providers may use the Provider Finder when referring their patients to your practice.

Updates to Clinical Practice and Preventive Care Guidelines

We’ve updated our Clinical Practice Guidelines and Preventive Care Guidelines. The guidelines draw from evidence-based standards of care and nationally recognized medical authorities to help direct our quality and health management programs and help improve member care. They may help guide your decision-making as you care for our members. Read more on News and Updates.

Prior Authorization Requirement Changes for Some Government Programs Plans Effective Oct. 1, 2023

BCBSIL is changing prior authorization requirements for Blue Cross Medicare Advantage (PPO)^SM, Blue Cross Community Health Plans^SM (BCCHP^SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)^SMmembers. Read more on News and Updates.

Survey Assesses Medicare Advantage Members’ Health Outcomes

The Centers for Medicare & Medicaid Services sends a Health Outcomes Survey (HOS) to a sample of our members from August through November. The survey asks members in Blue Cross Medicare Advantage^SM and prescription drug plans to rate their last six months of care.

2023 Illinois Medicaid Quality Improvement Program Updates

Beginning with the 2023 Performance Year, changes will be made to the Medicaid Primary Care Quality Improvement Program for participating providers with 1,000 or more members.

ClaimsXten™ Quarterly Update Effective Dec. 4, 2023

BCBSIL will implement its fourth quarter code updates for the ClaimsXten auditing tool on or after Dec. 4, 2023.