Download open the file... - Excellus BlueCross BlueShield

Connection
Excellus BlueCross BlueShield
Newsletter for Medical Office and Facility Staff
VOLUME: 16.4
ISSUE: December 2009
A nonprofit independent licensee of the BlueCross BlueShield Association
H1N1 Vaccine Billing
Serum
In this issue:
Click the title below to go directly to the article.
¾ Coverage for Bariatric Surgery for
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
¾
Medicaid Managed Care and Family
Health Plus Members…p.2
Accurate Practice Status Information
Needed…p.2
2010 Benefit Changes and Product
Discontinuance…p.3-4
CMS-Mandated Training is Due
December 31…p.5
Check ID Cards!…p.5
Update -Technology and Business
Enhancement Project…p.6
New Process for Medical Records
Submission…p.7
Claim Adjustment Requests…p.8
Claim Submission Reminders…p.8
Cold and Flu Prevention: Tips to Keep
Your Patients Healthy and Out of the
ER…p.9
Closed for the Holidays…p.9
Medicare Risk Adjustment Coding
Update…p.10
Behavioral Health Resources for
Pediatricians and Family Practice
Physicians…p.11
Behavioral Health Continuity and
Coordination of Care…p.11-12
eCommerce Implements New Telephone
Hours…p.12
Classic Blue Product Membership
Increase in 2010…p.13
Performance Improvement Coaching
Program…p.13
Physician Recognition Program…p.14
Change to Appeals Process for CCN
Decisions…p.14
Federal Employer Program Wellness
Incentive…p.15
FEP Benefit Change – After-Hours
Care…p.15
HEDIS Osteoporosis Standard of
Care…p.16
Adverse Reimbursement Changes to
Contracts…p.16
HIPAA 5010 Frequently Asked
Questions…p.17
Also:
Medical Policy Updates
News from FLRx
Navigating the Blues
FEP Sample Incentive Forms
We would like to remind you that the cost of the H1N1 vaccine is covered by
the federal government and not by Excellus BCBS, as such, codes G9142 or
90663 for the H1N1 serum are not required to be reported on the claim.
However, if your office or facility wishes to include the code for tracking
purposes, please bill with a $.01 charge. Currently, our claim processing
systems are unable accept a $0.00 charge.
Note: If the H1N1 vaccine code appears on the claim, the line will deny -
"Service provided at no cost to member or provider, member not liable.”
Administration
Excellus BCBS covers the administration cost of the H1N1 vaccine in full for all
members at the same allowance as administration of the seasonal flu vaccine —
even for plans that do not provide coverage for adult immunizations.
Copayments, coinsurance and deductibles will not apply for the administration
of the vaccine for members enrolled in Excellus BCBS’s fully insured health
insurance plans or in self-funded plans where the employer has not opted out
of such coverage.
Please report the administration of the vaccine with the following codes:
Physicians/Flu Clinics/County Health Departments
CPT code 90470 or HCPCS code G9141 H1N1 immunization administration (intramuscular, intranasal),
including counseling when performed
Facilities
Revenue code 771 - vaccine administration - with HCPCS code G9141
The New York state Department of Health is responsible for directing the flow
of the H1N1 vaccine. For more information, visit the DOH Web site,
http://www.health.state.ny.us/diseases/communicable/influenza/h1n1/health
care_providers/.
Providers interested in obtaining H1N1 vaccine for medical practices in counties
outside of New York City must preregister via the following Web site,
https://hcsteamwork1.health.state.ny.us/pub/top.html.
Excellus BCBS supports the CDC and DOH recommendations on the best ways
to manage, prevent, and treat both seasonal flu and H1N1. Additional
information about the H1N1 vaccine is available on the CDC Web site,
www.cdc.gov. For your convenience, here are some specific links:
http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm
http://www.cdc.gov/h1n1flu/qa.htm
http://www.cdc.gov/flu/protect/habits.htm
If you have questions on H1N1 billing, please call Provider Service.
Coverage for Bariatric Surgery for Medicaid
Managed Care and Family Health Plus Members
Excellus BCBS would like to remind you about an upcoming change in bariatric
surgery coverage for Medicaid Managed Care and Family Health Plus members.
This change does not apply to commercial lines of business.
Effective January 1, 2010, in accordance with Department of Health policy, Excellus BCBS will reimburse for
bariatric surgery only when performed at certified centers for bariatric surgery or hospitals designated by the DOH
as “Bariatric Specialty Centers.” This applies to both inpatient and outpatient procedures. All existing utilization
management for bariatric surgery will continue to apply.
Members enrolled in these products will continue to be able to receive these services, but they will be directed to
approved facilities. To ensure that you have the most current list of approved facilities, please visit the Centers for
Medicare & Medicaid Services Web site, http://www.cms.hhs.gov/MedicareApprovedFacilitie.
Accurate Practice Status Information Needed
The start of a new year is a good time to review the practice information that we have on file for you to be sure that
it’s accurate and up to date. This information is contained in the Provider Directory on our Web site,
excellusbcbs.com, and serves as a reference guide for members seeking your services.
Please take a few minutes to go to our Web site and verify the practice information currently listed. From the home
page, click on the Find a Doctor link at the bottom of the screen. Then click on the link for Upstate New York
Provider Network. Select the Excellus BCBS health plan(s) that your office participates with and enter the provider’s
first and last name, then scroll down and click Search.
A key aspect of the demographic information that you provide is your practice status. Every practitioner is
responsible for evaluating his/her practice’s capacity and for maintaining access to office visits in accordance with
New York state standards. It is important to advise our organization as to whether the practice is open or closed to
new patients so that we can include this information in your directory listing.
Additionally, if your practice is open, but limited to patients meeting certain criteria, (e.g., adolescents only, women
only, diseases only, etc.), this should be noted in your directory listing. Provide this information under the heading
“Additional Information” on the Provider Information Update form. You may complete the form and submit it
electronically via the Web site, excellusbcbs.com, or print a copy of the form and fax or mail it to us.
To access, go to: For Providers > Online Services > Update Practice Information. To complete the form online, you
must be a registered Web site user.
For assistance registering, or for a Web tutorial, please contact your Provider Relations representative.
Please remember that access to quality health care and services is vital to our shared mission of serving our
members. If your practice is closed, now is a good time to consider changing the status to open or open/accepting
only.
If you have questions, please contact Provider Service.
Connection 2
December 2009
2010 Benefit Changes and Product Discontinuance
We would like to remind you of benefit changes and product discontinuance effective January 1, 2010. The
following benefit changes will be made to our HealthyBlue and Blue Healthy Choices products.
HealthyBlue
„
Maternity Benefits: Covered in full – no copay (only applies to copay option)
„
Prescription Drug Coverage: $0 generics for children to age 19; and up to a maximum of 90-day
supply of generic medications at a participating network pharmacy at one copay for each 30-day supply
for all members (applies to copay, copay and deductible and high deductible health plan options)
„
DME, External Prosthetics/Orthotics, Medical Supplies and Foot Orthotics*: Covered at 50
percent coinsurance for both in/out-of-network (only applies to copay and deductible health plan options)
* Only applies to certain groups, therefore, it is important to verify benefits before rendering service.
Blue Healthy Choices
„ Emergency Room Copay: Increased by $50 –
Healthy Family Option A: $100
Healthy Family Option B: $150
Product Discontinuance
Blue Point Select Options have been discontinued for calendar year 2010. We have advised our
members and employer groups and encouraged them to transition into other Excellus BCBS health
benefit programs.
SSA (Support Services Alliance) MemberOption Products
Several modifications have been made to our MemberOption products for calendar year 2010, including:
Product Discontinuance
Members enrolled in the MemberOptions Benefit Plans listed below have been encouraged to
transition to other health benefit programs:
„ XL300
„ XL1000LO
„ XL1500
„ XL1700H
New Product
A new plan option referred to as XL5600H. Under this plan, all services, with the exception of preventive
care, are subject to the annual deductible (preventive care is subject to the deductible when rendered by
non-participating providers). For two-person and family plans, the full family deductible must be met
before any claims are eligible for payment.
Deductible:
Out-of-pocket
max:
Single
$5,600
Family
$11,200
$5,600
$11,200
(Continued on following page)
December 2009
Preventive care services
covered in full
- Mammography
- Routine GYN exams and pap smears- up to
two per year
- Adult physicals - one per year
- Adult immunizations
- Well child care
- Routine prostate screening
- Colonoscopies
Connection 3
2010 Benefit Changes and Product Discontinuance
(cont.)
SSA (Support Services Alliance) MemberOption Products (cont.)
Product Name Change
The deductible and out-of-pocket maximum for MemberOptions Benefit Plan XL1250H has increased,
resulting in the following product name change effective January 1:
Current Name
XL1250H
New Name
XL1500H2
Members will receive new ID cards containing the updated product name. A sample of the new ID card
is below for your reference.
Sample ID Card Benefit Updates The following benefit changes are effective January 1 for MemberOptions Benefit Plans XL1500H2,
XL2600H, XL2500 and XL2250H2:
Hospital Outpatient Services:
Routine Mammogram, Pap smear,
Colonoscopy
Covered in Full
Physician Office Services:
Adult Routine Physician Exam -limit one per
calendar year, Adult Immunizations, Routine
Mammogram, Routine GYN Visits, Routine
Prostate and Colonoscopy Screening
Home Care
Covered at 80 percent, subject to
the deductible for 100 visits per
member per calendar year
Note: For XL2500, Home Care services
will remain covered at 80 percent,
subject to a $50 deductible for 100 visits
per member per calendar year
As we transition into the new year, remember to check member ID cards, photo IDs and to verify eligibility and
benefits before rendering services. Please be aware that you may have patients who are currently enrolled in
products that are being discontinued and have referrals/preauthorizations on file for services to be rendered after
January 1. These patients may contact your office to request that the referrals/preauthorizations be transferred to
their new coverage prior to the service date.
If a patient provides you with an ID card that lists the discontinued product on or after January 1, please contact
Excellus BCBS immediately to confirm coverage.
If you have questions regarding these changes, please call Provider Service.
Connection 4
December 2009
CMS-Mandated Training is Due December 31
Have you completed the CMS-mandated fraud, waste and abuse training? If not, visit the Excellus BCBS Web site
to access our convenient, online training presentation to assist providers with meeting the requirement for the
Centers for Medicare & Medicaid Services-mandated training.
The training presentation can be accessed via the Excellus BCBS Web site, excellusbcbs.com. From the provider
home page, click News and Updates. Under Updates, click on the Fraud, Waste and Abuse Provider Training link.
The presentation is approximately 20 minutes long, and it may be downloaded to your computer for even more
convenient viewing by all members of your staff. Providers may obtain the training from a source other than
Excellus BCBS (e.g., another payer’s training program), but you must still attest to Excellus BCBS that the training
was completed. Failure to provide attestation may result in the suspension of your contract with the
Health Plan.
Whether you utilize the Excellus BCBS training or obtain it from another source, providers must file an attestation
of completion electronically by following the link on excellusbcbs.com entitled, Fraud, Waste and Abuse Provider
Training Attestation. Excellus BCBS must receive the provider’s attestation by December 31, 2009.
Only one attestation needs to be completed per practice. You do not need “e-signature” capability to complete
the form. Simply type your name in the field provided.
To ensure that all members of your staff have completed the training by the deadline, please login to the Web to
review the fraud, waste and abuse presentation. For more information about this mandated training, visit the
following Web sites:
„
„
„
http://edocket.access.gpo.gov/2007/07-5946.htm
http://edocket.access.gpo.gov/cfr_2007/octqtr/pdf/42cfr423.504.pdf
http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/PDBManual_Chapter9_FWA.pdf
Please contact your Provider Relations representative if you have any questions.
Check ID Cards!
It is always important to check your patient’s ID cards and photo ID at every visit; however, as we enter a new
year— it’s imperative.
Many people switch health plans on the first of the year. Additionally, employer groups may change the share of
costs that employees must pay (copays and deductibles) for health care services. To ensure you have the most
current information on file, make a copy of the card for your records.
Subscriber ID cards carry vital information to assist you in submitting clean claims. Make sure to confirm the
following information:
Subscriber name: Is your patient on the subscriber’s policy? Verify via the Excellus BCBS Web site,
excellusbcbs.com. Go to: For Providers > Online Services > Check Member Eligibility.
„ Subscriber prefix: This information is essential to ensure proper claim processing.
„ Copay amount(s)
„ Preauthorization: Check for specific preauthorization requirements and Customer Service telephone
number(s).
„
December 2009
Connection 5
Update -Technology and Business
Enhancement Project
New Monthly Health Summary
As part of our efforts to Build a Better Health Plan, Excellus BCBS is
introducing a monthly health summary for members with claims processed
on the new Facets 4.51 system. It will replace most explanations of benefits.
The health summary will provide a record of the claims processed for each
member of the subscriber’s family during the month.
Members enrolled in PPO, indemnity and other non-managed care products receive an EOB every time a medical
service claim is processed. The summary will provide a snapshot of the family’s claims, along with information to
help members better manage health care resources.
EOBs will still be available to members on demand for all claims and Excellus BCBS will continue to send EOBs for
some claims - for example, when the member is receiving a check.
Rendering Provider and Taxonomy Information
Please remember, claims for all lines of business must be submitted with rendering provider information. For the
Rochester region, this also applies to nurse practitioners and physician assistants.
In the near future, Excellus BCBS will require that all claim transactions contain taxonomy codes. To ensure a
smooth transition, start including taxonomy codes on every claim now. If you are a provider with more than one
specialty, be sure to bill with the appropriate code.
Submitting claims with rendering provider and taxonomy information incorporates best practice solutions into all
claims processing procedures. It will also ensure that claims are processed in the most accurate and timely manner.
Moving More Members to Facets
On January 1, 2010, we intend to move additional members to the new Facets system and new business processes.
We will move a select portion of our HealthyBlue (alpha prefix VYI) business, as well as the total membership of our
new low-cost product, SimplyBlue (alpha prefix VYS).
As we continue to move more members to Facets, please make sure to ask for member ID cards at every visit. This
will ensure that you have the most up-to-date information on file and assist you in submitting clean claims.
PaySpan Health - Electronic Remittances
PaySpan Health is a vendor that we utilize for the delivery of the electronic remittance (835) and the electronic
funds transfer. If your office currently receives the 835 and EFT through PaySpan, you will need to register for
Facets using the registration codes that PaySpan mailed to your office in September.
Registration is required to ensure delivery of the 835 and EFTs for all claims processed on Facets. Until registration
is complete, you will receive paper remits and paper checks for patients who have been converted to the Facets
system. Registering with PaySpan is easy and can be completed online. Simply visit the PaySpan Web site,
www.payspanhealth.com. A valid e-mail address is required.
For assistance, contact your Provider Relations representative.
Connection 6
December 2009
New Process for Medical Records Submission
Excellus BCBS is implementing a new initiative to streamline its processes for requesting,
obtaining and processing medical records. Effective January 1, 2010, providers
must submit medical records upon initial claim submission for those services
that are considered experimental/investigational or that require
determinations for medical necessity. This requirement will only apply to claims for
Excellus BCBS members; Blue Card® claims will not require up-front submission.
Here are answers to some frequently asked questions about this new initiative
Q:
Which codes require up-front submission of medical records?
A:
Providers should have received a full listing of these codes with a provider
bulletin dated November 11, 2009. If you do not have this information, the bulletin
and list of codes are posted on our Web site, excellusbcbs.com. Click For Providers>
Administration > News and Updates.
Q:
Why don’t I don’t see any codes for mental health services on this list?
A:
This new initiative does not affect the request and submission of medical records for behavioral health
and substance abuse services.
Q:
If I obtained preauthorization for a service that appears on the list, will I still need to submit
medical records with the claim?
A:
No. Up-front submission of records will not be required if preauthorization was obtained from the Health
Plan prior to rendering the service.
Q:
I forgot to submit records with a code requiring it, and the claim denied, “Medical Records
Submission Guideline Not Followed.” How do I appeal this denial?
A:
Providers may submit a new claim with the records for reimbursement consideration. No appeal process is
necessary as long as the new claim and records are submitted within timely filing limits. Please note that
providers may not hold the member liable for claims denying for this reason.
Q:
I just received a letter from Excellus BCBS requesting medical records related to a claim.
Isn’t Excellus BCBS requiring up-front submission of records and no longer requesting them?
A:
Up-front submission of records is required for services that are experimental/investigational or that
require medical necessity review. However, Excellus BCBS will continue to request medical records for
services rendered to a member whose contract requires review for that service. For contractual reviews,
Excellus BCBS will continue to contact the provider via letter to request any required clinical information.
If after 45 days the requested information is not received, a denial will be issued and the member will be
held harmless.
If you have any additional questions regarding the new medical records initiative, please contact Provider Service.
December 2009
Connection 7
Claim Adjustment Requests
We would like to remind you of acceptable formats for submitting a claim adjustment request to Excellus BCBS.
Web Site: Providers who are registered users of the Excellus BCBS Web site, excellusbcbs.com, may request an
adjustment electronically through an interactive online form. Providers may also submit related additional
information, such as medical records, electronically. To access, go to:
For Providers > Online Services > Claims > Request Claim Adjustment.
Paper Request for Research/Claim Adjustment Form: An Adobe® PDF of the Request for Research/Claim
Adjustment form is available on the Excellus BCBS Web site or you may request a paper copy from Provider
Service. You do not need to be a registered Web site user to obtain this form. To access, go to:
For Providers > Administration > Forms & Templates > Billing and Remittance > Request for Adjustment.
Attach a copy of the remittance advice that included the claim, a copy of the original claim form, and other
relevant supporting documentation. Please do not submit adjustment requests by fax. Requests should be
submitted via U.S. mail or e-mail (see below).
E-mail:
[email protected]
Mail:
Excellus BlueCross BlueShield
PO Box 22999
Rochester, NY 14692
If a claim denied for no authorization, but there was an authorization on file, you may use the Request for
Research/Claim Adjustment form and attach a copy of the authorization.
Timely filing requests and clinical editing review requests may not be submitted via the Request for
Research/Claim Adjustment form. If you are submitting a request to override a timely filing denial, please
submit these requests via the Request for Timely Filing Review form available on the Excellus BCBS Web site or
from Provider Service. To access, go to: For Providers > Administration > Forms & Templates > Billing and
Remittance > Request for Timely Filing Review. The Clinical Editing Review Request form may be found here:
For Providers > Administration > Forms & Templates > Billing and Remittance > Clinical Editing Review Request
Form.
Provider Service - For straightforward adjustment of a limited number of claims, representatives may be
able to take the information over the phone to initiate an adjustment. If documentation is required, you may be
advised to use the Request for Research/Claim Adjustment form.
Claim Submission Reminders
At Excellus BlueCross BlueShield, our goal is to process all claims at initial submission. However, before we can
process a claim, it must be completed accurately. Here are some reminders to consider when submitting claims.
„ NPI, Tax ID and Taxonomy: Make sure to use the correct NPI, Tax ID and taxonomy numbers.
„ Patient Information: Be sure that patient information is accurate. We regularly receive claims
with incorrect patient information including date of birth, address, etc. Please double-check keying
before submitting the claim.
„ Other Insurance Information: Please do not enter information in the “other insurance” field
unless the patient truly has coverage under another carrier. Recently, we have received several
claims with Excellus BCBS copay indicated as the other insurance carrier’s paid amount.
We hope you find these tips to be helpful. If your office would like assistance with billing claims, please contact
your Provider Relations representative to schedule training.
Connection 8
December 2009
Cold and Flu Prevention: Tips to Keep Your Patients Healthy
and Out of the ER
Every winter, people with colds or the flu fill emergency rooms, only to be told to go home, rest and drink fluids.
We remind you to discuss with your patients the difference between emergent, urgent and primary care, along
with where to obtain care for each type of service.
Here are some tips to share with your patients to keep them out of the emergency room for nonemergent symptoms:
With an illness such as a cold or the flu, be sure to instruct patients to call your office first to get
instructions on how to treat symptoms before they make an unnecessary trip to the emergency room.
„ Clearly post any extended-care hours your office may offer to keep patients out of the emergency room.
„ Urgent care centers may also be a good alternative to offer patients when office hours are not available.
Post a list of nearby urgent care centers that your patients may seek out as an alternative to the
emergency room.
„
Here are some tips to share with your patients to keep them healthy this
cold and flu season:
„
„
„
„
„
„
„
„
„
Get vaccinated: According to the Centers for Disease Control, vaccination
against the flu each year is the single best way to help prevent the flu. Since
the virus and the vaccine changes every year, it is important to get a
vaccination annually.
Wash your hands: Frequent hand washing helps to keep germs out of our
bodies, including the influenza and H1N1 virus.
Stay home if you don't feel well: Keep germs from spreading by staying
home.
Do the elbow cough: Cough into elbows, not hands, where bacteria and
viruses are more likely to spread through touch.
Eat a well-balanced diet: Make sure to include extra fruits and fruit juices.
Get enough sleep: Eight hours of sleep per night is strongly
recommended.
Exercise regularly: Exercise for 20 minutes three or more times a week.
Don’t smoke: Smoking damages air passages, making them less able to resist
virus attacks.
Keep humidity high: Low humidity indoors during winter dries out
respiratory passages, which may increase susceptibility to cold and flu viruses.
Use a humidifier to help keep relative humidity at 30 to 45 percent.
Closed for the Holidays
Excellus BCBS offices will be closed for the holidays on
the following dates:
Wishing
you a happy
and healthy
holiday
season!!!
Thursday, December 24, 2009
Friday, December 25, 2009
Friday, January 1, 2009
December 2009
Connection 9
Medicare Risk Adjustment Coding Update
As we continue efforts to improve submission of accurate diagnoses and Medicare risk
scores, the Medicare Risk Adjustment department at Excellus BCBS would like to review
basic diagnosis coding guidelines and documentation when coding diabetes.
Specificity in Coding Diabetes
Coding conventions require the highest level of diagnosis specificity. Three-digit codes with
subdivisions indicate a necessity to utilize the appropriate subdivision code when submitting the diagnosis. Many
subdivisions can be coded by adding a fourth digit to the main code in question. Others, such as diabetes
(250.XX), require a fifth digit to code the condition properly. The fifth digit in diabetic coding indicates whether
the condition is type 1 or type 2 and controlled or uncontrolled. Your documentation should reflect the chosen
specificity.
Tips for Accurate Diabetes Coding
Type 1 - patient’s body is unable to produce insulin
Type 2 - patient’s body is unable to use insulin properly
- The need to use external insulin to treat the condition is not the determining factor
- If the type of diabetes is not documented, the default is type 2
- Controlled or uncontrolled require provider documentation; it’s not determined by specific blood sugar
lab values
- Code all acute, history of, and chronic conditions as documented*
Diabetes and Peripheral Vascular Disease
The cache of diabetes diagnoses coding includes conditions that are uncomplicated and those that are
complicated by the manifestations of other organ problems. Peripheral vascular disease (PVD) may occur
simultaneously with diabetes or occur because of the patient’s diabetes. In either situation, both conditions must
be coded. However, in the latter situation, the diabetes code would indicate a causal relationship between
diabetes and the peripheral vascular disease.
When assigning the codes for diabetes with peripheral circulatory disorders (250.7X), it must be sequenced
before the code for the associated circulatory disorder.
Tip!
A cause-and-effect relationship is not assumed in patients who have diabetes and peripheral vascular disease.
The physician must document that the PVD is diabetic or due to the diabetes.**
If you have any questions, please contact one of our Medicare Risk Adjustment coordinators:
„ Charlotte Kolbeck: (315) 671-7009
„ Denise Hull: (716) 857-6280
„ Arlene Ogie: (585) 339-7727
„ Karen Taylor: (585) 339-7728
* History of COPD, Coding Clinic, 2nd quarter 1992, page 16 to 17
** Diabetes and peripheral vascular disease cause-and-effect, Coding Clinic, 2nd Quarter 1994, page 17
Connection 10
December 2009
Behavioral Health Resources for Pediatricians and
Family Practice Physicians
It’s estimated that more than 10 percent of children and adolescents have a psychiatric
illness and only a small portion receives psychiatric services. This is partly due to a shortage
of child and adolescent psychiatrists nationally and in upstate New York. These factors result
in a demand for pediatricians and family practitioners to treat psychiatric illnesses in their
offices, often without adequate training or support.
Excellus BCBS has implemented an initiative to assist pediatricians and family practitioners
by offering e-mail and telephone educational consultation with Dr. James Wallace, a board-certified child and
adolescent psychiatrist.
E-mail consultation requests should be sent to [email protected]. Dr. Wallace will respond weekly
at the times below.
„ Educational phone consultations with Dr. Wallace are available weekly by calling 1 (585) 249-6220 at
the times below.
„
Questions?
Weekly
e-mail &
telephone
availability:
Mondays: 4:30 p.m. - 5:30 p.m.
Fridays: 12:30 p.m. - 1:30 p.m.
If Dr. Wallace is unavailable, Dr. Lisa Rosica will conduct consults at the same phone number and times.
For the most efficient use of the phone consult resource, please have questions formulated and chart in hand,
including detailed history of any medication trials and mental health or special education services.
Please do not send or share protected health information, which includes any individually identifiable health
information, such as patient name, address, date of birth and/or Social Security number.
Only essential clinical details should be shared and clinical information should be modified as needed to ensure
confidentiality. We will require the patient’s county of residence as well as the name of the insurance product in
which he or she is enrolled.
Behavioral Health Continuity and Coordination of Care
In accordance with the National Committee for Quality Assurance and the DOH, the Excellus BCBS Behavioral
Health department monitors continuity and coordination of care. Monitoring is important to ensure that our
members receive seamless, continuous and appropriate care, and to strengthen system-wide continuity between
medical and behavioral health care.
The Behavioral Health department collaborates with behavioral health practitioners to:
„
„
„
„
Evaluate and assist as to when exchanges of information between providers are necessary
Determine the content of the exchange
Ensure that after the intake assessment, follow-up is timely (no later than the third visit), and appropriate
Ensure that the patient’s written consent has been obtained
(Continued on following page)
December 2009
Connection 11
Behavioral Health Continuity and Coordination of Care
(cont.)
Recordkeeping
The patient’s record must contain written release forms that specify each caregiver by name. It must indicate
with whom information may be shared or indicate the patient’s refusal to have information released. This includes
a written release of information for the patient’s primary care physician (required by the DOH, which supersedes
the HIPAA requirements).
Evidence of continuity of care between the behavioral health provider and the primary care physician is a clinical
quality of care requirement. Evidence of continuity includes written communications and/or documentation of
telephone conversations that includes an assessment, working DSM IV diagnosis and a clinical plan of care.
Accuracy and details are extremely critical when the patient has medical and behavioral health comorbidities and/or
taking multiple medications.
Continuity of Care
As deemed necessary, there is evidence of continuity of care between the behavioral health provider and consultants,
ancillary providers and health care institutions. Necessary collaboration includes sharing or obtaining a summary of
recent behavioral health clinical inpatient or outpatient care in the last 12 months and/or pertinent treatment
information via written or telephonic communication that is included or documented in the treatment record.
Visit our Web site for Continuity of Care and Recordkeeping Tools!
Tools for continuity of care are included with the recordkeeping forms available via the Excellus BCBS Web site,
excellusbcbs.com. From the provider page, go to: Patient Care > Behavioral Health > Behavioral Health Tools
and Resources. A paper copy is available upon request.
If you have questions, please contact the Behavioral Health Quality Management department at
1 (800) 240-6956 or e-mail Brian Moser at [email protected].
eCommerce Implements New Telephone Hours
Effective December 1, the Excellus BCBS eCommerce department changed its telephone hours to the following:
- Hours of Operation Monday through Thursday: 8 a.m. to 4:30 p.m.
Friday: 9 a.m. to 4:30 p.m.
eCommerce Toll-free Number: 1 (877) 843-8520
Connection 12
December 2009
Classic Blue Product Membership Increase in 2010
prefix
We would like you to be aware that effective January 1, 2010, 38 employer groups within the
Central New York and Central New York Southern Tier regions will move to our Classic Blue
traditional indemnity product. Members enrolled in Classic Blue have a three-character alpha
of ZFW. New plastic ID cards will be issued to members over the next few weeks.
Remember to check ID cards and photo ID at every visit to ensure that you have the most current
coverage information on file.
Performance Improvement Coaching Program
In response to the demand placed on primary care physicians by their certifying boards to incorporate quality
improvement activities in the practice setting, Excellus BCBS has designed a menu-driven coaching program
called Performance Improvement Coaching. The objective is to support physicians who are engaged in their
certifying board’s Maintenance of Certification (MOC) as they complete the required quality improvement
component.
Nurse consultants from the Physician Performance Improvement department are available free of charge to
advise physicians engaged in this process. In addition to helping to navigate the MOC process, nurse consultants
can provide advice on how to identify and implement a quality improvement activity that is relevant to the specific
practice and offer valuable tools and resources.
Currently, approximately 50 physicians participate in the program. Results from a physician survey to evaluate the
effectiveness of the program revealed:
PPI nurse consultants are viewed by physicians/office staff as having in-depth knowledge of the MOC
requirements and processes
„ Physicians view the PPI team as an important resource
„ Physicians are receptive to the role of nurse consultants in process improvement activities
„ Physicians view the assistance of the PPI nurses as an appropriate health plan activity
„
If you would like to speak with a nurse consultant as you complete the quality improvement component of MOC,
please call 1 (800) 768-8177.
BlueWorks Distinction Awarded to Performance Coaching
We are please to announce that the Performance Coaching Program received a BlueWorks distinction award. For
more information about this year’s winning programs and other Harvard-recognized programs that have been
awarded the BlueWorks distinction, visit http://www.bcbs.com/innovations/blueworks/.
December 2009
Connection 13
Physician Recognition Program
Excellus BCBS recognizes the value of the primary care specialty board’s MOC programs as relevant measures of
performance in practice. Physicians with a valid American Board of Internal Medicine certificate and enrolled in
ABIM’s MOC program may elect to authorize ABIM to submit electronic verification of practice improvement
module (PIM) completion to Excellus BCBS. This authorization takes place via the ABIM Web site, www.abim.org.
Physician login is required. Once you login, go to the Optional Reporting to Third Parties page.
Physicians may authorize ABIM to submit the following information to Excellus BCBS:
„
„
„
„
„
An identification number specified by the health plan
Physician’s full name and location (city and state)
Physician’s certification status (whether the physician has a valid certificate in internal medicine or an
internal medicine subspecialty)
Physician’s MOC status (confirmation that the physician is presently enrolled)
The name of the completed PIM and the date of completion
Excellus BCBS will recognize physicians who have completed a PIM by noting this in the online provider directory.
We are working with the American Board of Family Medicine to define a process for recognizing diplomats who have
completed their Part IV – Performance in Practice Module.
Change to Appeals Process for CCN Decisions
Excellus BCBS would like to inform you of a change in procedure for filing appeals based on medical decisions made
by CareCore National for commercial and safety net products.
Effective November 1, 2009, if your office wishes to file an appeal based on a medical decision made by CCN,
you must contact Excellus BCBS’s Provider Service department to initiate the appeal. Regional toll-free telephone
numbers for Provider Service are listed below for your convenience.
Any calls placed to CCN related to an appeal on or after November 1 will be referred to Excellus BCBS.
We have updated our Provider Reference Guide to reflect this information and you may view and print a copy
from our Web site, excellusbcbs.com. Go to: For Providers > Online Services > Preauthorizations > Radiology
Services. A link to the updated Provider Reference Guide is included under the Program Information section. If
you do not have Internet access, you may contact Provider Service to request a paper copy.
If you have any questions, please contact Provider Service.
Regional Provider Service Telephone Numbers
Central New York and CNY Southern Tier: 1 (800) 920-8889
Utica: 1 (800) 311-3536
Rochester: 1 (800) 462-0116
Connection 14
December 2009
Federal Employer Program Wellness Incentive
Beginning January 1, 2010, members enrolled in the Federal Employee Program (FEP) will be
rewarded when they complete either an adult Blue Health Assessment or a child Body Mass
Index Assessment. The intent of the program is to encourage wellness and disease prevention
and to remove barriers to care. Both programs are free of charge for members and are
available on the FEP Web site at: http://www.fepblue.org/myblue/index.html.
The member will be rewarded enhanced benefits, including:
Adult Incentive
If an adult member completes our Blue Health Assessment, the copayment for his or her subsequent annual
physical examination or an individual preventive counseling visit will be waived. The member must complete the
assessment and present the certificate of completion at the time of the visit in order for the copayment to be
waived.
Child Incentive
Children who complete a BMI Assessment will receive a certificate to waive up to four nutritional counseling visits.
This incentive is limited to children ages 5 through 17 whose BMI falls in the 85th percentile or higher, according
to standards established by the Centers for Disease Control and Prevention.
Only children who meet these requirements will be presented with a certificate. The member must present the
certificate of completion at the time of the visit in order for the copayment to be waived. For your reference,
samples of the certificates are provided in the back of this newsletter.
How does it affect my office?
„
„
„
„
„
If a member presents a certificate, please do not collect a copayment. Excellus BCBS’s reimbursement for
the visit will include the copayment.
If a member presents a certificate and an office visit copayment is collected in error, you will be required
to refund the member upon receiving payment from Excellus BCBS.
To ensure correct reimbursement, the claim must be filed with the appropriate evaluation/management
procedure code and diagnosis (e.g., routine/annual examination for adults or nutrition therapy/nutritional
counseling for children).
The certificate may be retained for your records; however, it is not required to be submitted with the
claim.
The child certificate encompasses four visits, so please sign and date the certificate so the member can
track usage of visits.
What action do I need to take?
Please ensure that your office is aware of the program and process for handling the certificates, especially
those who collect member copayments and arrange appointments.
„ Beginning on January 1, follow the instructions above when a certificate is presented by a FEP member.
Note: For your convenience, certificates contain handling instructions.
„
We hope that these programs will encourage wellness and prevention. We appreciate your support of this
program.
FEP Benefit Change – After-Hours Care
Effective January 1, 2010, FEP members enrolled in Basic and Standard Option benefit plans (member ID
begins with an “R”) will no longer have a benefit for after-hour care (shift differential services). If members
enrolled in these plans obtain after-hour care, they will be fully responsible for the cost of services rendered.
If you have questions, please contact the FEP Service unit toll-free at 1 (800) 252-2209.
December 2009
Connection 15
HEDIS Osteoporosis Standard of Care
The National Committee of Quality Assurance requires Medicare managed care plans to
provide the following osteoporosis management for women age 67 or older who suffer a
fracture:
to
a
„ Bone mineral density (BMD) test, or
„ Prescription drug treatment for osteoporosis within six months of the fracture date
Excellus BCBS measures this requirement in our annual Health Effectiveness Data and Information Set (HEDIS)
data collection. The HEDIS measure criteria include:
Osteoporosis
management in
women who had
a fracture
Women who received the following within six months of suffering a
fracture:
„
„
Age 67 and older
Bone mineral density (BMD) test
Prescription for a drug to treat or prevent osteoporosis within six
months following the fracture
Exclusions:
Women who received screening and/or treatment in the year prior
to the fracture.
„ Fractures of the finger, toe, face and skull
„
Osteoporosis codes:
„
CPT Codes: 76070,76071,76075-76078,76977,77078-77083,78350,78351
„
HCPCS Code: G0130
„
ICD-9CM Diagnosis Code: V82.82
„
ICD-9CM Procedure Code: 88.98
For the most current list of medications covered for the treatment of osteoporosis, visit the Excellus BCBS Web
site, excellusbcbs.com. From the provider page, go to: Prescription Drugs > Check Our Drug List.
Adverse Reimbursement Changes to Contracts
Effective January 1, 2010, in accordance with New York State Insurance and Public Health Law, Excellus BCBS
must notify professional providers 90 days prior to making an adverse reimbursement change to their contract.
In the event that a provider objects to the change, he or she may terminate the contract within 30 days of
receiving notification of the adverse reimbursement change.
This does not apply to facilities or institutional providers, such as hospitals, nursing homes, home care agencies,
hospices, labs, dialysis facilities, clinics or diagnostic and treatment centers.
Connection 16
December 2009
HIPAA 5010 Frequently Asked Questions
HIPAA 5010 is a new, required format for submitting data for transactions and code sets to be implemented by
all users of electronic transactions supporting health care delivery by January 1, 2012.
We would like to share answers to some frequently asked questions regarding the new format.
Q. What HIPAA transactions does 5010 address?
A. 5010 addresses the following transactions:
„
837 - Institutional Claim
„
837 - Professional Claim
„
837 - Dental Claim
„
835 - Electronic Remittance
„
270/271 - Eligibility Benefit Inquiry and Response
„
276/277 - Claims Status and Response
„
278 - Services Request for Review and Response
„
834 - Benefit Enrollment and Maintenance
„
820 - Premium Payments
„
997/TA1 - Transaction Submission Response
Q. What is the time frame for implementation of HIPAA 5010?
A. HIPAA 5010-compliant transactions will be required by January 1, 2012. However, Excellus BCBS will be ready to
accept HIPAA 5010-compliant transactions by January 1, 2011.
Q. How can I contact Excellus BCBS with questions regarding implementation?
A. Questions regarding implementation can be sent via e-mail to [email protected].
Q. Where can I find general information regarding HIPAA 5010?
A. You can find more about HIPAA 5010 on the CMS Web site,
www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp
December 2009
Connection 17
A nonprofit independent licensee of the BlueCross BlueShield Association
MEDICAL POLICY UPDATES
December 2009
To ensure that the development of corporate medical policies occurs through an open, collaborative
process, we encourage our participating practitioners to become actively involved in medical
policy development. Each month, draft policies are posted in the Provider section of our Web site,
excellusbcbs.com, for participating practitioners’ review and comment. To access, select For Providers >
Medical Policies > Preview & Comment on Draft Policies (located on the left side of the menu under
Medical Policies).
The following policy is tentatively scheduled to be available for comment in December:
„
Ophthalmologic Techniques for the Diagnosis of Glaucoma
Corporate medical policies are used as a guide. Coverage decisions are made on a case-by-case basis
and in accordance with the member's contract. While a technology or service may be medically
necessary, payment of benefits is subject to the member's eligibility on the date the service is rendered
and the benefit/exclusion provisions in the member's contract. Before rendering care, providers should
verify the member's eligibility for the service by calling the Provider Service department of your local
plan.
Complete, detailed policies are available on our Web site, excellusbcbs.com. Click on For Providers >
View Our Medical Policies. Questions regarding medical policies may be directed to your Provider
Relations representative or to the Provider Service department of your local health plan.
Medical policies are also located on the Web site for Excellus BlueCross BlueShield members at
excellusbcbs.com. To access our policies, members can select For Members > Health and Wellness >
Help with Illness >View our Medical Policies.
Medical policies apply to commercial and Medicaid products only when a contract benefit for the specific
service exists. Excellus BCBS medical policies only apply to Medicare products when a contract benefit
exists and where there are no national or local Medicare coverage decisions for the specific service. A link
to CMS coverage has also been provided at the end of each medical policy if a CMS coverage
determination exists. Please refer to the Centers for Medicare & Medicaid Services for medical policies
pertaining to Medicare contracts.
Web sites for review of CMS policies are:
For the national Medicare coverage determinations:
http://www.cms.hhs.gov/MCD/index_list.asp?list_type=ncd
„ For local New York state Medicare policies:
http://www.cms.hhs.gov/mcd/results_index.asp?from2=results_index.asp&contractor=181&fr
om='lmrpstate'&retired=&name=National%20Government%20Services,%20Inc.%20(13202,
%20MAC%20-%20Part%20B)&letter_range=4&
„
Please note: Although medical policies are effective on the date they are approved by the Medical
Policy Committee, updates to the claims processing systems may not occur for up to 90 days.
The following new and updated medical policies have been reviewed and approved by the Corporate
Medical Policy Committee, including practitioner representatives from Excellus BlueCross BlueShield,
Central New York, Central New York Southern Tier, Utica and Rochester regions.
Continued on the following page
Connection
December 2009
NEW POLICIES recently approved
There were no new policies to report this month.
CURRENT POLICIES recently updated
Allogeneic Stem Cell Support/Transplant involves the infusion of stem cells obtained from a
matched donor after a patient’s bone marrow has been eradicated by high-dose chemotherapy or total
body irradiation to destroy malignant cells. High-dose chemotherapy with allogeneic stem cell support
has been proven medically effective and is considered medically appropriate in certain conditions that are
further outlined in the medical policy. Several coverage changes for leukemias, lymphomas, myeloplastic
diseases, and amyloidosis have been made with this year’s update.
Autologous Stem Cell Support/Transplant involves the reinfusion of a patient’s own stem cells after
his/her bone marrow has been eradicated by high-dose chemotherapy or total body irradiation to destroy
malignant cells. High-dose chemotherapy with autologous stem cell support has been proven medically
effective and is considered medically appropriate in certain conditions that are further outlined in the
medical policy. Several coverage changes for leukemias, lymphomas, myeloplastic diseases, and
amyloidosis have been made with this year’s update.
The Bone Growth Stimulators policy addresses the use of electrical and ultrasonic stimulation. Bone
growth stimulators/fracture healing devices are considered medically appropriate for specific indications
outlined within the medical policy.
Genetic Assay of Tumor Tissue to Determine Prognosis of Breast Cancer (e.g., Oncotype DxTM,
MammaPrint®) has been proposed as a test to improve patient selection criteria for adjuvant
chemotherapy in breast cancer treatment by determining specific risk factors through examination of
gene expression in tumor tissue. Based on our criteria and assessment of peer-reviewed literature, the
use of Oncotype DXTM assay is considered medically appropriate to guide the decision related to the need
for adjuvant chemotherapy in women with newly diagnosed breast cancer when ALL of the following
criteria have been met:
„ Breast cancer is unilateral, non-fixed;
„ Breast cancer is hormone receptor positive;
„ Breast cancer is HER-2 negative;
„ Tumor size is 0.6-1.0 cm with moderate/poor differentiation or unfavorable features or tumor
size is greater than 1 cm;
„ Breast cancer is axillary node negative;
„ There is no evidence of metastasis;
„ Chemotherapy is not precluded due to other factors; and
„ The test result will determine the decision whether to treat the patient with adjuvant
chemotherapy AND when the affirmative decision to treat with adjuvant endocrine therapy
(e.g., tamoxifen or aromatase inhibitors) has been made. (New criterion with this year’s
update).
The use of all other gene expressional profiling assays, including, but not limited to MammaPrint® ,
Aviara MG1, Mammostat TM, and Breast Cancer Gene Expression Ratio, are considered investigational as
there is insufficient evidence demonstrating the benefit of these assays in predicting chemotherapy
benefit over conventional methods.
Intraocular Lens Implants are used to replace the natural lens and restore the optical focusing power
of the eye after cataract surgery. The more common replacement lenses include monofocal, multifocal or
accommodating IOLs. Monofocal or fixed focal IOLs are the current standard of treatment. Based upon
our criteria and assessment of peer-reviewed literature, the use of a monofocal IOL as replacement of
the natural crystalline lens of the eye following cataract extraction is considered medically appropriate.
The use of an astigmatism-correcting IOL, a multifocal IOL or an accommodating IOL following cataract
extraction is considered not medically necessary, as no superior medical benefit for these lenses has
been demonstrated over the monofocal IOL other than decreasing the need for corrective eyewear.
Magnetic Resonance Angiography (MRA) is a technique for imaging vascular anatomy and
pathology without the use of standard contrast agents or ionizing radiation, although a special form of
contrast (such as gadolinium) may be given to make the MRA images even clearer. MRA of the head,
neck, abdomen and chest is considered medically appropriate for patients suspected of having specific
Connection
Continued on the following page
December 2009
disease processes as listed in the policy. A new policy statement was added with this year’s update that
lists those indications for an MRA that would be considered medically appropriate if an MRI is
inconclusive (MRI being the preferred test of choice).
Neuropsychological Testing uses standard techniques to objectively test behavioral and cognitive
abilities comparing the patient’s results to established normal results. The need for neuropsychological
testing is indicated when there have been notable behavioral and/or cognitive changes associated with
severe head trauma or brain disease. Specific indications for neuropsychological testing that are
considered medically appropriate are outlined within the policy. This year’s update has added the
following coverage statement: Use of a computer-based neuropsychological assessment of a sportsrelated concussion (e.g., ImPACT, CogState Sport®, HeadMinder), in order to determine if an athlete is fit
to return to play, is considered not medically necessary.
Surgical Stockings and Compression Garments are custom-made or custom-fitted support for the
upper and lower extremities. Prescription, custom-made or custom-fitted surgical stockings/graduated
compression garments (e.g., Circaid, Juzo, Jobst, Sigvaris, ReidSleeve) are considered medically
appropriate for specific conditions outlined in the medical policy. This year’s update has added language
related to the use of Belisse® garments. The Compressure Comfort® Bra by Belisse® is contoured
similarly to a bra, however, it is not considered a mastectomy bra. The garment applies gentle
compression all around the torso and is considered medically appropriate if used for treatment of
lymphedema of the armpit, chest, breast, and/or back.
Vagus Nerve Stimulation (VNS) is considered medically appropriate when used as a treatment for
medically refractory seizures in patients for whom surgery is not recommended or in whom surgery has
failed. VNS is considered investigational for the treatment of medically refractive depression, as this
treatment method has not been proven effective in improving clinical outcomes.
CURRENT POLICIES recently updated with minimal changes
The following policies required only minimal changes (e.g., updating references, changing language to
meet legal needs). The coverage intent of the policies was not altered. These policies were
recently approved for updating by the Health Plan Medical Directors and are available on our Web site:
„
„
„
„
„
„
„
„
„
„
„
„
Ambulatory Event Monitors
Auditory Processing Disorder Testing
Cosmetic and Reconstructive Procedures
Deep Brain Stimulation
Erectile Dysfunction
External Insulin Pumps
HER-2 Testing in Invasive Breast Cancer Using FISH or IHC
Medically Necessary Services
Oximeters and Oximetry for Home Use
Phototherapy for Seasonal Affective Disorder
Prolotherapy
Wireless Capsule Endoscopy
Connection
December 2009
News From FLRx
The Excellus BlueCross BlueShield Internal Pharmacy Benefit Administrator
Prescription Drug Medication Guide Changes for 2010
Excellus BlueCross BlueShield is committed to effectively managing prescription drug benefit costs and
providing our members with affordable access to prescription drugs.
Our Pharmacy and Therapeutics Committee, which is made up of practicing community physicians and
clinical pharmacists, regularly reviews the drugs on our formularies. The committee’s most recent
evaluation of our three-tier formularies resulted in classification changes for a small number of
medications effective January 1, 2010. A summary of the changes is provided in the table below.
Medications being reclassified to Tier 3 (highest copayment/coinsurance) beginning January 1, will
affect new and existing users.
Drugs Reclassified from Tier 1 to Tier 3
Reclassification Increases Member Copayment/Coinsurance Amount
Therapeutic Class
Drug Reclassified to Tier 3
Women’s Health: Hormones
Alora®
Drugs Reclassified from Tier 2 to Tier 3
Reclassification Increases member Copayment/Coinsurance Amount
Therapeutic Class
Drug Reclassified to Tier 3
Eye: Glaucoma
Lumigan®
Asthma: Inhaled Steroids
Pulmicort Inhaler®
Asthma: Inhaled Beta Agonists/ Inhaled
Respiratory Drugs
Xopenex HFA®
Step Therapy
Beginning January 1, 2010, step therapy will be required for the following:
Drug Class
Step Therapy Required for:
Requires trial of:
Seizure/Pain
lamictal
lamotrigine
A preview of our 2010 Medication Guide is available on our Web site, excellusbcbs.com.
(Continued on following page)
December 2009
News From FLRx
The Excellus BlueCross BlueShield Internal Pharmacy Benefit Administrator
Medical Specialty Drug Reminder
Medical specialty drugs require preauthorization; as such, claims will deny or suspend for review across
all lines of business if preauthorization is not obtained.
For a complete listing of medications that require preauthorization under the medical benefit, visit our
Web site, excellusbcbs.com. Go to: For Providers > Prescription Drugs > Drug Management Programs
>Prior Authorization Request Forms > List of Provider Administered Drugs Requiring Preauthorization.
Please reference the Web site frequently for updates to the medication list as new drugs are added as
they receive FDA approval.
Note: When calling Customer Service for a benefit quote for an office-administered medication,
including chemotherapy, drug names and/or J-code or both should be given to the representative.
If you have any questions, please contact the FLRx Pharmacy Help Desk at 1 (800) 724-5033.
December 2009
Navigating the Blues - 2010 Schedule
Please join our Provider Relations representatives for a Navigating the Blues training session in your
area. Navigating the Blues is designed for new members of your staff who may need
training on Excellus BCBS policies and processes. Navigating the Blues provides valuable
information on how to identify Excellus BCBS products and variations in product requirements,
BlueCard£, how to verify patient copay and patient eligibility, and much more!
Two sessions will be offered on each of the dates below.
„
„
Morning Sessions: 9-11 a.m. - For billing staff
Afternoon Sessions: 1-3 p.m. - For front-end/registration staff
Syracuse
February 18
March 10
April 8
May 12
June 17
July 15
Dates:
August 19
September 16
October 14
November 18
December 8
Location: Excellus BCBS
Lewis Training Room
333 Butternut Drive
Syracuse, NY 13214
Rochester
Dates:
February 18, March 17 and April 15
Location: Excellus BCBS
Room 243
165 Court Street
Rochester, NY 14647
Elmira
Dates:
February 19
March 19
April 16
May 21
June 18
July 16
August 20
September 17
October 15
November 19
December 17
Location: Excellus BCBS
150 North Main Street
Elmira, NY 14901
August 10
September 14
October 12
November 9
December 14
Location: Excellus BCBS
53 Chenango Street
Binghamton, NY 13901
Binghamton
Dates:
February 2
March 9
April 13
May 11
June 8
July 13
Utica
Dates:
February 4
March 18
April 15
May 13
June 17
July 15
August 19
September 16
October 14
November 18
December 16
Location: Excellus BCBS
Utica Business Park
12 Rhoads Drive
Utica, NY 13502
Se
ee the following page for registration information.
Navigating the Blues Registration
YES, I am interested in attending a Navigating the Blues session!
Complete this form and fax it to Provider Relations at the appropriate number for your area
(listed below). Registration should be submitted at least one week prior to the seminar date.
To: Provider Relations
From:_________________________________________________________
(Print Office Name and Phone Number)
Region:_______________________________________________________
Session Date: ________________________
Time: (check box)
Morning: Billing staff
Afternoon: Front-end/registration staff
Attendee Name(s):________________________________________________
(Print First and Last Name)
Attendee Phone Number(s):________________________________________
Once completed, please fax this form to:
„
Rochester: (585) 399-6664
„
Syracuse: (315) 671-6799
„
Utica: (315) 797-4298
„
Elmira: (607) 732-7624
„
Binghamton: (607) 723-2896
Registration begins 30 minutes prior to session start time.
We look forward to seeing you!
%
CONTRACT ID#
MEMBER NAME
• If you collect an office visit copayment in error
for this visit, you will be required to refund
this amount to the member upon receiving
ceivin
payment from the BlueCross BlueShield Plan.
• To ensure correct reimbursement this claim
must
m be filed with the appropriate evaluation/
management
ma
procedure code and diagnosis
to reflect that the visit was primarily a routine/
annual examination.
!
3
• Please do not collect copayment
opaym amount
from the member at time
me of visit. Your
reimbursement for this visit will include the
payment of the copayment.
nt
Provider Information and Instructions
• If you have a question about this certificate or
the process, please contact the local BlueCross
BlueShield Plan.
• You may retain this certificate for your records;
it is not required to be submitted with the claim.
One (1) Free Annual Physical Examination
Preventive Counseling Office Visit
amination or Individual Pr
at a BlueCross BlueShield Plan Preferred Provider. Vali
Valid from XX/XX/XXXX to XX/XX/XXXX.
This certificate entitles the above Service Benefit
B
Plan member to:
XXXXXXXXXXXXXX
XXXX
________________________________________
__________________________
Sample A. Sample
________________________________________
MyBlue Wellness Certificate
XXXXXXXXX
%
CONTRACT
RACT ID#
ID
MEMBER NAME
_____________________
DATE
_____________________
DATE
________________
________________________________________
PROVIDER SIGNATURE
SIGNAT
____
________________________________________
PROVIDER
PROV
SIGNATURE
URE
_____________________
DATE
_______________________
________________________________________
PROVIDER
OVIDER SIGNATURE
SIGNA
• If you collect an office visit copayment in error for
any of these visits, you will be required to refund
• Please do not collect copayment or coinsurance
urance
amount from the member at time of visit.
sit. Your
reimbursement for these visits will include
de
the payment of the member copayment or
coinsurance.
• Please sign and date the certificate when
presented by the member in
n order for the member
to track usage of visits.
• You may retain this certificate for your records after
the fourth visit; it is not required to be submitted
with the claim.
• To ensure correct reimbursement this claim
must be filed with the appropriate medical
nutrition therapy/nutritional counseling codes
and diagnosis to reflect the visit was primarily a
nutritional counseling visit.
this
thi amount to the member upon receiving
payment
from the BlueCross BlueShield Plan.
pa
A Blue Cross & Blue Shield Service Benefit Plan Program
• If you have a question about this certificate or
the process, please contact the local BlueCross
BlueShield Plan.
_____________________
DATE
____________
________________________________________
PROVIDER
OVIDER SIGNATURE
Provider Information
on and Instructions
❑ Visit #4 Acknowledgement:
❑ Visit #3 Acknowledgement:
t:
!
3
❑ Visit #2 Acknowledgement:
❑ Visit #1 Acknowledgement:
This certificate entitles the above
e Service Benefit Plan member
m
to:
Four (4) Nutritional Counseling Visits with no member cost-share at a BlueCross BlueShield Plan
Preferred Provider upon presentation of this
his certificate. Valid
Va from XX/XX/XXXX to XX/XX/XXXX.
XXXXXXXXXXXXXX
XXXXX
________________________________________
_____________________
Sample A. Sample
________________________________________
MyBlue Wellness Certificate
XXXXXXXXX
165 Court Street
Rochester, New York 14647
PRSRT STD
U.S. POSTAGE
PAID
ROCHESTER, NY
Permit No. 201