Download BlueCard Survey - Blue Cross of Northeastern Pennsylvania

2006 BlueCard® Program Satisfaction Survey …
We Appreciate Your Feedback
Since you are a participating BlueCard Program provider, your satisfaction is our top priority. Blue Cross
of Northeastern Pennsylvania values the care that you provide to Blue members. With your feedback, we
can identify ways to serve you more effectively.
Last year’s survey results found that providers continue to experience significant improvements in their
satisfaction with the BlueCard Program. Specifically, they noted service delivery enhancements in the
following areas:
 Claims accuracy
 Claims timeliness
 Satisfaction with resolving problem claims
 Electronic eligibility verification
 Customer service
 Provider education
The following are some of the initiatives that were implemented in 2005 to better serve you:
 BlueCard Provider Stakeholder Panel – Randomly selected local BlueCard providers are
surveyed on-line by the Blue Cross Blue Shield Association to examine provider satisfaction
about various topics facing our BlueCard provider network today.
 BlueCard Northeast Regional Quarterly meetings – Meeting held with Northeast BC BS Plans to
help resolve BlueCard provider and member issues.
 2005 BlueCard Provider Satisfaction Call- Back Program – Provider requested followup upon
completion of the 2005 BlueCard Annual Provider Satisfaction Survey.
 Bi-weekly “internal” BlueCard Provider Issues meeting – Meeting held on behalf of our BlueCard
provider network to ensure issues are resolved in a timely way.
To continue evaluating our performance, we have asked The Response Center, an independent research
company, to conduct telephone interviews on our behalf. Their staff will contact a randomly selected
sample of providers who provided care for BlueCard members during 2005. This year’s survey will be
administered in two waves to give us a more up-to-date picture of your satisfaction. The fi rst set of
telephone interviews will be administered in April-May with the second set scheduled for fall.
A representative from the Response Center will ask to speak with the person in your office who is most
knowledgeable about fi ling Blue Cross and Blue Shield claims and/or someone in the Billing Department.
Please alert the appropriate staff in your office that they may be contacted for this survey.
If you receive a call, please take a moment to participate, as your feedback is important to us. If you have
questions about the BlueCard Program or have suggestions for improvement, you may contact us by:
 Speaking with your Provider Relations Consultant.
 Contacting our Customer Service Department at (888) 827-7117.
Thank you in advance for taking the time to provide us with your feedback.
BCNEPA/FPH Implementing Acute Inpatient Rehabilitation Guidelines
Effective May 1, 2006, the following guidelines, with regard to acute inpatient rehabilitation, will be
implemented by BCNEPA and First Priority Health.
Acute rehabilitation is appropriate for candidates with a disability arising from an acute event or illness
resulting in significant loss of function, which requires considerable assistance in mobility and activities of
daily living. Each candidate must show potential for improvement through the use of an intensive
multidisciplinary acute rehabilitation program with a reasonably set time frame.
The rehabilitation patient candidate must have at least one of the following diagnoses, with onset or
functional decline within 30 days of admission, or within six months if never given the opportunity for
rehabilitation, and all other criteria are met: amputation, burn, major multiple trauma, neurological
disorder, polyarthritis/rheumatoid arthritis, spinal cord injury, stroke, or brain injury (occurrence 12 months
or less) Rancho level 4 or greater.
Requests for admission for patients with diagnosis of peripheral neuropathy without motor deficit or with a
diagnosis of “deconditioning” can usually be cared for in a skilled nursing environment and will require
review with a Medical Director on a case-bycase basis.
Acute rehabilitation is usually not medically necessary for the vast majority of joint replacement patients
who can be safely discharged from the hospital with home health. A small number of patients may require
skilled nursing facility admission for safety or other concerns.
Requests for acute rehabilitation admission with diagnosis of hip or knee replacement will require review
with a medical director except in cases that involve frail, elderly patients or morbidly obese patients (BMI
greater than or equal to 40).
The Rehabilitation Risk Scoring Sheet for total joint replacement will no longer be used.
Requests for admission with medical disorders resulting in a progressive deterioration: i.e., Parkinson’s
disease, cancer, and COPD, for example, are not considered appropriate candidates for acute
rehabilitation. Request for admission for patients with a diagnosis of multiple sclerosis can be considered
by a medical director on a case-by-case basis.
For patients meeting the diagnostic criteria, the following additional criteria must all be met. Patients
must:
 Be medically stable in the acute inpatient setting.
 Be able to learn and demonstrate carry-over.
 Be capable of active participation in two or more disciplines of therapy (OT, PT, speech and
cognitive) and multidisciplinary team approach.
 Have the ability and willingness to participate in a minimum of three hours of treatment per day.
 Have the expectation for significant reportable improvement within a predictable amount of time.
 Have a complete evaluation of functional status and rehabilitation needs.
 Consent to the treatment in the program and demonstrate willingness and motivation to
participate in the rehabilitation program.
 Have goals for rehabilitation that have been established and are specific, measurable, realistic
and timely.
Other limitations and exclusions, intensity of service requirements and discharge criteria may apply.
(Policy Update 0804004)