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REVIEWSMFOR CONTRACTING INSTITUTIONAL AND PROFESSIONAL PROVIDERSMAY 2015WHAT’SINSIDE?Women’s Contraceptive Drug List Reminder 22014 HMO Quality Site Visit Results 22013 HEDIS Initiation and Engagement ofAlcohol and Other Drug Dependence Results 3ClaimsXtenTM System Edit Updates,Effective June 2015 4Join Us for an iExchange Webinar 6Provider Learning Opportunities 6, 7View Our New Videos on Palliative Care 7ICD-10: Be a Part of the SolutionICD-10-CM diagnosis codes will be required on all professional and outpatient claims withdates of service on or after the compliance date of Oct. 1, 2015, as established by the U.S.Department of Health and Human Services (HHS). Both ICD-10-CM diagnosis and ICD-10-PCSprocedure codes will be required on all inpatient institutional claims with discharge dates onor after Oct. 1, 2015. Service dates or discharge dates prior to Oct. 1, 2015, will require ICD-9codes. Use of other codes, such as Current Procedural Terminology (CPT ), HCPCS andRevenue Codes will not be impacted by this change.The bottom line is this: The transition to ICD-10 is happening and there is a lot you need to doto prepare. Here are four ways you can take action, right now.1. Talk to Your Software Vendor, Billing Service or ClearinghouseYour focus is caring for your patients, but your claims also need your attention. To preparefor ICD-10 you need to consider how your claims are submitted and by whom. If you use anElectronic Health/Medical Record (EHR/EMR) system, Practice Management System (PMS)or Health Information System (HIS), have you contacted your software vendor to confirm thatall necessary updates will be completed and ready for you and your practice by the compliancedeadline? Or, if you use a billing service or clearinghouse, have you contacted them to makesure they are ready to submit compliant claims on your behalf?2. Start adding ICD-10 to referrals and orders for future services likely to occur Oct. 1, 2015,and later.The provider receiving your referral or order often relies on your diagnosis for their ownbilling. If you are not sure when the future service will occur, include both ICD-9 and ICD-10codes on your request.3. Ask About Testing with UsTesting is important to help identify possible issues well before the Oct. 1, 2015, ICD-10compliance date. Blue Cross and Blue Shield of Illinois (BCBSIL) began provider ICD-10testing in April 2015. If you are interested in testing with us, please contact your assignedProvider Network Consultant. Or, send an email to icd@bcbsil.com – please include “ICD-10TESTING REQUEST” in the subject line of your email. Provider ICD-10 testing at BCBSIL isscheduled to run through Sept. 15, 2015.4. Take Our ICD-10 Readiness AssessmentWe encourage you to complete our brief online ICD-10 Readiness Assessment. Surveyresponses will help us understand what types of communication materials and resources youand your staff need to help you achieve compliance. A link to the ICD-10 Readiness Assessmentwill be available on the Home page of our Provider website through May 27, 2015. Generalresults will be shared in an upcoming issue of our provider newsletter. All individual providerresponses and contact information will be kept confidential.Questions? Please email us at icd@bcbsil.com and we will be happy to assist.CPT copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademarkof the AMA.VISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER
Women’s ContraceptiveDrug List ReminderUnder the Affordable Care Act(ACA), certain U.S. Food and DrugAdministration (FDA) approvedwomen’s contraceptives are coveredwith no member cost share whenin-network providers and pharmaciesare used. The list of women’scontraceptives covered by BCBSIL foreligible benefit plans was updated thisyear to include dosage strengths.Eligible members with prescriptiondrug coverage through PrimeTherapeutics may find the Women’sContraceptive Drug List in theMember Services/Prescription DrugPlan section of our website at bcbsil.com.If members have questions, they maycontact the number on the back of theirID card for assistance.2014 HMO Quality Site Visit ResultsBCBSIL performs practitioner site visits every two to three years to meet Illinois Department ofPublic Health requirements. During 2014, quality site visits were performed for independentlycontracted Primary Care Physicians and high volume Behavioral Health Practitioners in theHMO Illinois , Blue Advantage HMOSM and Blue Precision HMOSM networks.*Site visit results are compiled quarterly and analyzed typically on an annual basis. BCBSILresults for the visits continue to come in above 90 percent for many indicators, including facilityenvironment, safety, medical record systems, patient education and emergency preparedness.Opportunities for improvement exist in the area of members’ ability to access care duringextended weekday and weekend hours, and meeting Americans with Disability Act requirements,such as providing handicapped accessible signage and exam table(s). Indicators related tothe handling of expired and opened medications also provide an opportunity for improvementby providers.O P P O RT U N I T I E S FO R I M P ROV E M E N T I N T H E H M O N E T WO R KThe 2014 site visit results identified several categories which offer opportunities for improvementin medical record documentation in the HMO network. Site visit data indicate that someproviders are not consistently documenting the required elements listed below:Quality of Patient Care Assessment of physical activity for adults BMI percentile for children Alcohol use annually for both adults and adolescentsPrime Therapeutics LLC is a pharmacy benefitmanagement company. BCBSIL contractswith Prime to provide pharmacy benefitmanagement, prescription home delivery andspecialty pharmacy services. BCBSIL, as wellas several other independent Blue Cross andBlue Shield Plans, has an ownership interestin Prime.The fact that an item or service is describedin this article is not a guarantee of benefits.Members should refer to their certificate ofcoverage for more details, including benefits,limitations and exclusions. Regardlessof benefits, the final decision about anymedication is between the member and theirhealth care provider. Use of a standardized alcohol assessment tool for both adults and adolescents A ssessment of illicit substance use and recommending treatment if indicated for both adultsand adolescents Adolescent smoking history Smoking cessation advice for adults and adolescentsPreventive Colorectal cancer screening for adults age 50 and over Influenza vaccination for adults and children Aspirin use discussion for both males and females Chlamydia testing for females ages 16-24 Breast cancer screening and cervical cancer screening for females Hepatitis A vaccine for childrenThe BCBSIL site visit staff will usually meet with the physician and office personnel following thesite visit to provide results and identify the areas that may need improvement.SCHEDULING REMINDERSTo help us schedule your site visit, primary care physician offices are asked to consider the following: I f you use electronic medical records (EMRs), please inform us of this when we schedule yoursite visit and allow the BCBSIL auditor access to the EMR during the audit. If you need to cancel a site visit, please let us know five business days prior to the visit.Thank you for continuing to support BCBSIL in its quality improvement efforts. For additionalinformation regarding the Quality Site Visit standards and Site Visit Comparisons, visit theClinical Resources/Site Visits section of our website at bcbsil.com/provider.* Some of the providers are also contracted for the Blue Cross Community MMAI (MedicareMedicaid Plan) SM and Blue Cross Medicare Advantage (PPO) SM.2VISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER
2013 HEDIS Initiation and Engagement of Alcoholand Other Drug Dependence ResultsAs noted on the NCQA website, the Healthcare Effectiveness Data and Information Set (HEDIS)is a tool used by more than 90 percent of health plans in the U.S. to help measure performanceon important areas of care and service. Collectively, HEDIS consists of 75 measures across eightcategories of care.*HEDIS measurements that are specific to Behavioral Health services include, but are not limited to: Antidepressant medication management (AMM) Initiation and engagement in treatment following a substance abuse diagnosis (IET) Seven and 30-day follow up after a mental health hospitalization (FUH) Follow-up care for children prescribed ADHD medication (ADD)The IET HEDIS metric includes the percentage of adolescent (13 years) and adult members with anew episode of alcohol or other drug dependence who received the following services: I nitiation of Alcohol and Other Drug Dependence (AOD) Treatment – Treatment was initiated bymembers through an inpatient AOD admission, outpatient visit, intensive outpatient encounter orpartial hospitalization within 14 days of the diagnosis. E ngagement of Alcohol and Other Drug Dependence (AOD) Treatment – The percentage ofmembers who initiated treatment and who had two or more additional services with a diagnosis ofAOD within 30 days of the initiation visit.The goal of this measurement is to help ensure that members who receive an AOD diagnosis pursueand engage in treatment after the initial diagnosis.On an annual basis, HEDIS measurements are calculated and compared to national averages. The2013 national average for the IET Initiation was 40.15 and the 2013 national average for the IETEngagement was 14.06. In 2013, the average IET initiation for BCBSIL members was 40.44 and theIET Engagement was 15.18.W H AT I S B C B S I L D O I N G TO H E L P I N C R E A S E M E M B E R PA RT I C I PAT I O N ?BCBSIL has implemented a formal Quality Improvement Program (QIP) to help increase thenumber of members initiating and engaging in alcohol or other drug dependence treatment.Programs will be implemented to facilitate coordination with facilities and providers to identifymembers admitting with a diagnosis of alcohol or other drug dependence, as well as to assistmembers with setting up post-discharge follow-up care.W H AT C A N YO U D O TO H E L P ?You may identify patients during the initiation of treatment for substance dependence andencourage them to seek ongoing treatment to prevent future relapse. You may assist your patientsby discussing treatment options and facilitating follow-up care. If you feel that a patient may needcounseling or psychiatric referrals, you also have the option to refer them to the BCBSIL BehavioralHealth Case Management Program by calling the number on the back of the member’s ID card.To share feedback or learn more, visit the Clinical Resources/Behavioral Health Care ManagementProgram section of our website at ityMeasurement.aspxHEDIS is a registered trademark of the NCQA.The material in this article is for educational purposes only and is not a substitute for independent medical judgmentof health care providers. Providers are instructed to exercise their own independent medical judgment in treatingtheir patients.JULY 2015MARCHMAY20122013Medical PolicyUpdatesApproved, new or revised BCBSILMedical Policies and their effectivedates are usually posted on our websitethe first day of each month. Medicalpolicies, both new and revised, are usedas guidelines for benefit determinationsin health care benefit programsfor most BCBSIL members, unlessotherwise indicated. These policies mayimpact your reimbursement and yourpatients’ benefits.Although medical policies can be used asa guide, HMO providers should refer tothe HMO Scope of Benefits in the BCBSILProvider Manual, which is located in theStandards and Requirements section ofour website at bcbsil.com/provider.You may view active, new and revisedpolicies, along with policies pendingimplementation, by visiting the Standardsand Requirements/Medical Policy sectionof our website at bcbsil.com/provider.Select “View all Active and PendingMedical Policies.” After confirming youragreement with the Medical Policiesdisclaimer, you will be directed to theMedical Policies Home page.You may also view draft medical policiesthat are under development, or are inthe process of being revised, by selecting“View and comment on Draft MedicalPolicies.” After confirming youragreement with the Medical Policiesdisclaimer, you will be directed to theDraft Medical Policies page. Just clickon the title of the draft policy you wishto review, and then select “Comments”to submit your feedback to us.Please visit the Standards andRequirements/Medical Policy sectionof our website at bcbsil.com/provider foraccess to the most complete and up-todate medical policy information.The BCBSIL Medical Policies are forinformational purposes only and are not areplacement for the independent medicaljudgment of physicians. Physicians are toexercise their own clinical judgment basedon each individual patient’s health care needs.Some benefit plans administered by BCBSIL,such as some self-funded employer plans orgovernmental plans, may not utilize BCBSILMedical Policies. Members should contacttheir local customer service representativefor specific coverage information.53
Rendering Provider FeeSchedule ReminderClaimsXtenTM System Edit Updates,Effective June 2015Reimbursement is based on the typeof rendering provider indicated on theclaim. The provider types listed belowwill have the differentials applied tothe Schedule of Maximum Allowances(SMA) as noted:100 percent of the SMA Physician85 percent of the SMA Licensed Clinical Psychologist Certified Nurse Specialist Certified Nurse Practitioner Certified Registered Nurse Anesthetist Certified Nurse Midwife85 percent of 20 percent of the SMA Licensed Surgical Assistant Registered Nurse First Assistants70 percent of the SMA Licensed Clinical Social Worker L icensed Clinical ProfessionalCounselor Licensed Professional Counselor icensed Marriage and Family LTherapist Board Certified Behavioral Analyst Developmental TherapistBeginning on or after June 15, 2015, BCBSIL will enhance the ClaimsXten code auditing tool withthe following changes to the bundling logic in our claim processing system: E lectrocardiogram (ECG) CPT codes 93000, 93005 and 93010 will bundle to surgical andradiological CPT codes. This is in accordance with CPT, Centers for Medicare & MedicaidServices National Correct Coding Initiative (CMS NCCI) and industry auditing guidelines. Surgical procedure codes submitted with codes 88302, 88304, 88305, 88307 and 88309 will now besubject to CPT, CMS NCCI and industry auditing guidelines. Venipuncture codes 36400, 36405, 36406, 36410, 36415, 36416, 36420, 36425, 96523 and S9529will now bundle to all medical, surgical and laboratory procedure codes. This is in accordancewith industry standards that include consideration for phlebotomy charges in their globallaboratory fee schedule. Urinalysis codes 81002 and 81003 will now be subject to CMS NCCI auditing guidelines and willbundle to evaluation and management procedure codes (99201-99429). Preventive evaluation and management codes 99381-99429 submitted with office/outpatientevaluation and management codes 99201-99215 will now be subject to CPT, CMS NCCI andindustry auditing guidelines.In accordance with CPT/HCPCS guidelines, use of modifiers may impact the outcome of the finaladjudication of claims for the changes listed above. Consult your CPT codebook appendix A orHCPCS codebook for guidance in the appropriate use of modifiers.To help determine how coding combinations on a particular claim may be evaluated during theclaim adjudication process, you may continue to utilize Clear Claim Connection (C3). C3 is a free,online reference tool that mirrors the logic behind BCBSIL’s code-auditing software. Refer to theEducation and Reference Center/Provider Tools/ Clear Claim Connection section of our websiteat bcbsil.com/provider for additional details on C3 and ClaimsXten.ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent thirdparty vendor that is solely responsible for its products and services.Checks of eligibility and/or benefit information are not a guarantee of payment. Benefits will be determined once a claimis received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificateof coverage applicable on the date services were rendered.4VISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER
CMS Replaces Modifier 59 with New ‘X’ ModifiersEffective Jan. 1, 2015, the Centers for Medicare & Medicaid Services (CMS) added four new modifiersto replace modifier 59 when submitted with CPT/HCPCS codes. Modifier 59 was previously used toreport that a service was a distinct procedural service. Following are the new modifiers replacing modifier59 and their descriptions:X ModifierCMS DescriptionXE Separate EncounterA service that is distinct because it occurred during aseparate encounterXS Separate StructureA service that is distinct because it was performed on aseparate organ/structureXP Separate PractitionerA service that is distinct because it was performed by adifferent practitionerXU UnusualNon-OverlappingServiceThe use of a service that is distinct because it does not overlapusual components of the main serviceBeginning in late April 2015, BCBSIL enhanced the ClaimsXten code auditing tool by adding the firstquarter 2015 codes and bundling logic into our claim processing system. Currently, BCBSIL will acceptthe new modifiers when submitted.Third-Party Premium PaymentsAll BCBSIL Provider Manuals have been updated to include the following language:Premium payments for individual plans are a personal expense to be paid for directly by individualand family plan subscribers. In compliance with Federal guidance, Blue Cross and Blue Shield ofIllinois will accept third-party payment for premium directly from the following entities:(1) the Ryan White HIV/AIDS Program under title XXVI of the Public Health Service Act;(2) Indian tribes, tribal organizations or urban Indian organizations; and (3) state and federalGovernment programs.BCBSIL may choose, in its sole discretion, to allow payments from not-for-profit foundations,provided those foundations meet nondiscrimination requirements and pay premiums for the fullpolicy year for each of the Covered Persons at issue. Except as otherwise provided above, third-partyentities, including hospitals and other health care providers, shall not pay BCBSIL directly for anyor all of an enrollee’s premium.The BCBSIL Provider Manuals are available in the Standards and Requirements section of ourwebsite at bcbsil.com/provider.MARCHMAY20152012High-tech RadiologyManagement ProgramReminderEffective April 1, 2015, BCBSIL nolonger requires providers to obtainRadiology Quality Initiative (RQI)numbers through AIM SpecialtyHealth (AIM) prior to orderingoutpatient, high-tech diagnosticradiology services for Blue ChoicePPOSM members. This change alsoapplies to Blue Options PPOSM andBlue Choice Options PPOSM members.Providers should continue to followBCBSIL Medical Policy criteria whenapplicable. As always, checkingeligibility and benefits is an importantfirst step.Please note that the above-referencedchange applies only to Blue Choice PPO,Blue Options PPO and Blue ChoiceOptions PPO members at this time.Obtaining RQI numbers through AIMat aimspecialtyhealth.com will continueto be required by BCBSIL whenoutpatient high-tech diagnostic studiesare indicated for most other BCBSILmembers.* Facilities cannot obtainRQI numbers on behalf of orderingphysicians.* For City of Chicago members, including nonMedicare Retirees, determination of medicalnecessity through Telligen at 800-373-3727will continue to be required for approval ofCAT, MRI and PET scans.AIM Specialty Health (AIM) is an operatingsubsidiary of Anthem. BCBSIL makes noendorsement, representations or warrantiesregarding any products or services offered byindependent third party vendors, such as AIMand Telligen. If you have any questions aboutthe products or services they offer, you shouldcontact the vendor(s) directly.Please note that the fact that a guideline isavailable for any given treatment, or thata service has been pre-certified or an RQInumber has been issued is not a guaranteeof payment. Benefits will be determined oncea claim is received and will be based upon,among other things, the member’s eligibilityand the terms of the member’s certificateof coverage, including, but not limited to,exclusions and limitations applicable onthe date services were rendered. Certainemployer groups may require pre-certificationfor imaging services from other vendors. If youhave any questions, please call the number onthe back of the member’s ID card.75
Join Us for aniExchange WebinarBCBSIL continues to enhanceiExchange, our Web-based benefitpreauthorization tool. iExchangesupports online submission andelectronic approval of benefits forinpatient admissions and selectoutpatient services such as pharmacyand behavioral health. This f lexibletool enables you to send benefitpreauthorization requests 24 hours aday, 7 days a week and provides realtime responses.Once eligibility, benefits andpreauthorization requirementshave been confirmed, iExchangecan be accessed to initiate benefitpreauthorization and extensionrequests for approval prior to servicesbeing rendered.Learn MoreWe encourage you to attend aniExchange webinar this month foran overview of some of the mostimportant and commonly usedfeatures of this tool. Topics covered inthese webinars include: ICD-10 impacts to iExchange Behavioral health Pharmacy Electronic Provider Access Inpatient requests Outpatient requests Extensions Patient clinical summaryFor dates, times and registrationinformation, refer to the ProviderLearning Opportunities in this issue.Not enrolled for iExchange?Additional information on iExchange,including our online enrollmentform, is available in the Educationand Reference Center/ProviderTools section of our website atbcbsil.com/provider.Please note that the fact that a service hasbeen preauthorized/pre-certified is nota guarantee of payment. Benefits will bedetermined once a claim is received andwill be based upon, among other things,the member’s eligibility and the terms of themember’s certificate of coverage applicableon the date services were rendered.6Provider Learning OpportunitiesB C B S I L W E B I N A R S A N D WO R K S H O P SComplimentary training sessions are offered throughout the year with an emphasis onelectronic transactions. A snapshot of upcoming training sessions is included below so youcan mark your calendar. To register online, visit the Workshops and Webinars page in theEducation and Reference Center on our website at bcbsil.com/provider.WEBINARSOur online educational webinars are designed to train billing, utilization and administrative professionals about how to useavailable electronic options and the advantages of using these tools throughout the entire claims process.Introducing Remittance ViewerThe remittance viewer is an online toolthat offers providers and billing servicesa convenient way to retrieve, view,save or print claim detail information.May 20, 201511 a.m. to noonJune 17, 2015iExchange TrainingMay 20, 20152 to 3 p.m.Join us for an overview of this onlinebenefit preauthorization tool.June 3, 20152 to 3 p.m.BCBSIL PROFESSIONAL PROVIDER WORKSHOPSTThe BCBSIL Provider Relations team is offering specialized workshops for independently contracted providers.Topics such as ICD-10, ACA, behavioral health, product updates and more will be discussed.State House InnGovernor’s Ballroom101 E. Adams St.Springfield, IL 62701Registration:9 to 9:30 a.m.May 21, 2015Session:9:30 a.m. to noonThe registration deadline is May 15, 2015.Questions? Please contact Roy Pyers atRoy Pyers@bcbsil.com or 217-698-2524.Silver Cross Hospital1900 Silver Cross Blvd.New Lenox, IL 60451The registration deadline is June 5, 2015.Questions? Please contact Michelle Brownfield-Nance atmichelle brownfield-nance@bcbsil.com or 312-653-4727.Blue Cross and Blue Shield of Illinois300 East Randolph St.Chicago, IL 60601The registration deadline is June 19, 2015.Questions? Please contact Ana Hernandez athernandeza2@bcbsil.com or 312-653-6488.Community Hospital901 MacArthur Blvd.Munster, IN 46321The registration deadline is June 19, 2015.Questions? Please contact Kathy Barry atKathleen Barry@bcbsil.com or 312-653-4247.Registration:9 to 9:30 a.m.June 11, 2015Session:9:30 a.m. to noonRegistration:9 to 9:30 a.m.June 24, 2015Session:9:30 a.m. to noonRegistration:9 to 9:30 a.m.June 25, 2015Session:9:30 a.m. to noonVISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER
Provider Learning Opportunities(continued from p. 6)BCBSIL PROFESSIONAL PROVIDER WORKSHOPS (cont.)Edward Hospital801 S. Washington St.Naperville, IL 60540The registration deadline is July 10, 2015.Questions? Please contact Kathy Barry atKathleen Barry@bcbsil.com or 312-653-4247.Little Company of Mary Hospital2800 W. 95th St.Evergreen Park, IL 60805The registration deadline is July 10, 2015.Questions? Please contact Vickey Jones atjonesv@bcbsil.com or 312-653-6321.Northwest Community Hospital,The Learning Center800 W. Central Rd.Arlington Heights, IL 60005Registration:9 to 9:30 a.m.July 16, 2015Session:9:30 a.m. to noonRegistration:9 to 9:30 a.m.July 17, 2015Session:9:30 a.m. to noonRegistration:9 to 9:30 a.m.July 22, 2015Session:9:30 a.m. to noonThe registration deadline is July 17, 2015.Questions? Please contact Gina Plescia atGina Plescia@bcbsil.com or 312-653-4733.Williamson County Pavilion1602 Sioux DriveMarion, IL 62959The registration deadline is July 31, 2015.Questions? Please contact Teresa Trumbleyat trumbleyt@bcbsil.com or 618-998-2528.The Regency Conference Center400 Regency ParkO’Fallon, IL 62269The registration deadline is July 31, 2015.Questions? Please contact Teresa Trumbley attrumbleyt@bcbsil.com or 618-998-2528.Par-A-Dice Hotel21 Blackjack Blvd.East Peoria, IL 61611The registration deadline is Sept. 11, 2015.Questions? Please contact Amanda Williams atwilliamsa4@bcbsil.com or 217-698-5179.MARCHMAY20152012Registration:9 to 9:30 a.m.Aug. 5, 2015Session:9:30 a.m. to noonRegistration:9 to 9:30 a.m.Aug. 6, 2015Session:9:30 a.m. to noonView Our New Videoson Palliative CareIn late 2013 and early 2014, wepublished a series of articles on therelatively new specialty of palliativecare. As noted in these articles, itis never too early to “go palliative.”Unlike hospice care, palliative carecan be provided along with curativetherapy to help improve the qualityof life for patients and their families.Palliative care can also help patientswith serious illnesses to better controlpain and other symptoms, whichmay result in improved quality oflife and reduced emergency roomvisits, hospitalizations and rehospitalizations.To help encourage early referralsto palliative care for our members,Blue Cross and Blue Shield of Illinois(BCBSIL) is making available thefollowing videos: Palliative Care:Supporting Your Patients throughSerious Illness and Sam’s Story: PatientSupport through Palliative Care. Bothvideos are available in the ClinicalResources/Related Resources sectionof our website at bcbsil.com/provider.These videos feature Martha L.Twaddle, MD, FAAHPM, who hashelped to facilitate the growth anddevelopment of palliative and hospicecare on the national level. Dr. Twaddleis currently an Associate Professor ofMedicine at Northwestern UniversityFeinberg School of Medicine. Aformer President of the AmericanAcademy of Hospice and PalliativeMedicine (AAHPM), she also servedon the Steering Committee for theNational Consensus Project forPalliative Care.Registration:9 to 9:30 a.m.Sept. 16, 2015Session:9:30 a.m. to noon7
REVIEWPRSRT STDU.S. POSTAGEPAIDPERMIT NO. 581CHICAGO, ILFOR CONTRACTING INSTITUTIONAL AND PROFESSIONAL PROVIDERSBlue 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 AssociationBlue Cross , Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.IN THEKNOW Claim Status Availability to Change inAutomated Phone SystemEffective July 13, 2015, claim status requests will no longer be availablewithin the BCBSIL Interactive Voice Response (IVR) phone system.BCBSIL supports a number of online tools to help providers streamlineadministrative processes and minimize time spent by your staff onunnecessary phone calls. As of the effective date of the change, providerswill need to direct claim status requests electronically through their Webvendor of choice.Providers may continue to use the IVR phone system to obtain eligibilityand benefits information and Customer Advocates will remain availablefor other inquiries, such as claim adjustments.Additional information regarding the above-referenced change will bepublished in upcoming issues of the Blue Review as well as on ourProvider website.Checking eligibility and/or benefit information is not a guarantee of payment. Benefitswill be determined once a claim is received and will be based upon, among other things,the member’s eligibility, any claims received during the interim period and the terms of themember’s certificate of coverage applicable on the date services were rendered.VISIT OUR WEBSITE AT BCBSIL.COM/PROVIDER00014.0515Blue Review is a monthly newsletter published forinstitutional and professional providers contracting withBlue Cross and Blue Shield of Illinois. We encourage you t
1. Talk to Your Software Vendor, Billing Service or Clearinghouse Your focus is caring for your patients, but your claims also need your attention. To prepare for ICD-10 you need to consider how your claims are submitted and by whom. If you use an Electronic Health/Medical
