September 2017

Leadership Perspective

Disrupt or be disrupted?

Technology – and the innovation driving it – is shaping how we shop, travel and live our lives at home. But what about health care? This month, Steve Hamman, Senior Vice President of Enterprise Network Solutions, shares a message about industry disruptors and what Blue Cross and Blue Cross of Illinois (BCBSIL) is doing to help make the health care system work better for our customers and providers.

What’s New

Your Feedback is Important

With the Blue Review, BCBSIL strives to provide important information each month to our growing readership of independently contracted providers. We need your feedback to assess the effectiveness of this newsletter in delivering timely content that’s relevant to you and your staff. Please take a few minutes to complete our brief, 10-question survey. As a thank you for your time, we’re providing an opportunity for survey participants to win one of five, $25 Amazon.com^® gift certificates. (Note: Government employees and Health Care Service Corporation employees are not eligible. The Blue Review survey is not endorsed by, affiliated with or sponsored by Amazon.com.) Click here to take the survey now.

Wellness and Member Education

Colorectal Cancer Screening Options and Statistics – Get the Conversation Started

In 2017, the American Cancer Society (ACS) estimated there would be 135,430 new cases of colorectal cancer and 50,260 deaths nationwide. For Illinois alone, it was estimated that there would be 5,580 new cases of colorectal cancer with an estimated 2,030 deaths. Your recommendation that your patients get screened for colorectal cancer carries the greatest impact with your patients.

Claims and Coding

Blue Cross Medicare Advantage^SM Providers are Prohibited from Billing Dually Eligible Individuals Enrolled in the QMB Program

As a reminder, the independently contracted providers participating in the Blue Cross Medicare Advantage (PPO)^SM (MA PPO) and/or Blue Cross Medicare Advantage (HMO)^SM (MA HMO) member products may not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare cost-sharing. QMB is a Medicare Savings Program (MSP) that exempts Medicare beneficiaries from Medicare cost-sharing liability.

Medicaid Claim Denials for No Drug Rebate Agreement on File

As a reminder, National Drug Codes (NDCs) and all other required data elements must be billed on medical claims for Illinois Medicaid members. Additionally, a signed Medicaid Drug Rebate Agreement from each drug’s manufacturer, or pharmaceutical labeler, must be on file with the Centers for Medicare & Medicaid Services (CMS).

Pharmacy Program

Pharmacy Change for ICP and FHP Members, Effective Sept. 1, 2017

Beginning Sept. 1, 2017, TRUEplus^® and TechLITE^® is the preferred brand for insulin pen needles, and TRUEplus is the preferred brand for insulin syringes for the Blue Cross Community Integrated Care Plan (ICP)^SM and Blue Cross Community Family Health Plan^SM (FHP) Medicaid formularies.

Integration of Prime Therapeutics^® and Walgreens^® Specialty Pharmacy and Mail Order Services

BCBSIL’s pharmacy benefit manager (PBM), Prime Therapeutics LLC (Prime), and Walgreens announced a strategic alliance in August 2016 to create a first-of-a-kind model for pharmacy benefit management that aligns a national pharmacy chain, a leading PBM and health plans, including a long-term retail pharmacy agreement.

No Cost-share Coverage for Statin Use to Help Prevent Cardiovascular Disease in Adults

The United States Preventive Services Task Force (USPSTF) issued a recommendation last November regarding statin use for the primary prevention of cardiovascular disease (CVD) in adults without a history of the disease. Their recommendation is that adults use a low-to-moderate dose statin to prevent CVD if they meet certain criteria. As a result of this recommendation, BCBSIL will implement some changes to statin coverage.

Electronic Options

Visit Our Website for New Claim Payment and Remittance Resources

BCBSIL recently updated the Claim Payment and Remittance page in the Claims and Eligibility section of our website at bcbsil.com/provider. This section of our Provider website focuses on electronic transactions that may help increase administrative efficiencies for your office while also helping to make it easier for you to conduct business with BCBSIL.

Provider Education

Provider Learning Opportunities

BCBSIL provides complimentary educational workshops and webinars with an emphasis on electronic transactions, provider tools and helpful online resources. A list of upcoming training sessions is included in this month’s issue.

Notification and Disclosure

Fairness in Contracting

In an effort to comply with fairness in contracting legislation and keep our independently contracted providers informed, BCBSIL has designated a column in the Blue Review to notify you of any significant changes to the physician fee schedules. Be sure to review this area each month.

ClaimsXten^TM Quarterly Updates

New and revised Current Procedural Terminology (CPT^®) and Healthcare Common Procedure Coding System (HCPCS) codes are periodically added to or deleted from the ClaimsXten code auditing tool software by the software vendor.

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