Are your patients up to date?

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1 SUMMER 2014 Are your patients up to date? As your patients physician, you can play a big part in keeping them on track for preventive screenings. You have a stronger influence on the health of your patients than you may realize and you could contribute to a more positive quality of life for all your patients. Talk to your patients about the following preventive screenings: Breast cancer screening (mammogram), every 2 years Cervical cancer screening, every 2 years Colorectal cancer screenings Fecal Occult Blood Test (FOBT), annually Colonoscopy, every 10 years Flu vaccine, annually Body Mass Index (BMI)measurement and record, annually Assess balance and fall risk, with intervention, annually Discuss urine leakage and treatment, annually Discuss smoking cessation For your diabetic patients, even if their diabetes is controlled by diet A minimum of one Hemoglobin A1c, annually LDL screening, annually Dilated retinal exam, annually If not taking diabetic medications, microalbumin test, annually If on diabetic medicine, RAS antagonist medication filled For your hypertensive patients, blood pressure maintained at 139/89 or less For your female patients 67 and older who have had a fracture, bone mineral density test or osteoporosis prescription You are well aware the role preventive screenings and early detection take in keeping your patients healthy. Make sure they are up-to-date on all preventive screening by suggesting a wellness exam today. one TO one FOR HEALTHCARE PROFESSIONALS

2 True Blue Special Needs Plan Mandatory Testing Blue Cross of Idaho is proud to announce the expansion of benefits for our True Blue Special Needs Plan (HMO SNP). On July 1, 2014, True Blue Medicaid covered services expanded to include long-term support services for members on the Medicaid Aged and Disabled Waiver. Eligible members also receive expanded Medicaid Mental Health Benefits. As part of the plan expansion, the State of Idaho requires all contracting Medicare Advantage or Medicare-Medicaid Coordinated Plan Providers and/or their office managers to complete the Mandatory Assessments located on our secure provider website. To gain access to these assessments, please log onto our secure site bcidaho.com/ providers. Scroll down on the left side and select Medicare Medicaid Coordination Plan, you will see the Online Mandatory Training Assessments link as well as a hard copy Mandatory Training Assessments. If you opt to take the assessments hard copy, there is a Mandatory Training Completion form that needs to be filled out and sent back in, so we may apply credit to you for taking the assessments. If you opt to take the assessments online, you do not need to fill out the form; your completion of the assessments will be received by Blue Cross of Idaho via your logon to the website. If you have any concerns or questions regarding the True Blue Special Needs Plan, please contact your External Provider Relations Representative. Consumer Pricing Continues to Gain Transparency As you all know, the push for transparency in healthcare costs continues to grow. And Blue Cross of Idaho supports this movement. For several years, we ve provided our members access to a cost-comparison tool that allows them to compare common outpatient procedure costs among several facilities. This fall, Blue Cross of Idaho will launch a newer, more robust tool that will give members even more insight into healthcare pricing. Look for more information as we get closer to our launch date. 2

3 Provider Credentialing Requirements To comply with healthcare reform requirements, Blue Cross of Idaho must credential all new and current providers contracted under a PPO agreement. Months ago, we began issuing general statewide provider alerts soliciting credentialing applications, but we are now targeting communications to contracting providers who are not yet credentialed. Provider Alerts will be issued to clinics that employ providers currently covered under a PPO contract who are not yet credentialed. A credentialing application must be completed and returned for each provider listed. Providers not credentialed will lose their PPO contracting status with Blue Cross of Idaho. To obtain a credentialing application: Navigate to bcidaho.com/providers. Select Medical Providers. Select Provider Packet. Select the Contracting link for your specific practice type. Click on the Credentialing Application to open and print the document. Complete the application, attach it and all of the required supporting documentation to an and submit it to PR2PI@bcidaho.com or fax it to Blue Cross of Idaho must receive complete applications, including all required attachments, no later than October 1, If we don t receive a complete application for each PPO contracting provider, he or she will lose contracting status with Blue Cross of Idaho. The packet only needs to be completed once per provider, not once per service location. Packets are not required for hospital-based providers without a private practice (i.e. anesthesiologists, radiologist and pathologists). Good Bye Clearinghouse, Hello Direct Claim Entry! After careful consideration, Blue Cross of Idaho decided to no longer offer clearinghouse functionality on June 30, By accepting claims belonging to other payers, we risk exposing protected health information for not only our members, but members of other payers. We will continue to accept your electronic claims for Blue Cross of Idaho members and Blue Cross Blue Shield Association plans from other states. However, we will no longer offer the connection to other payers claims. Our EDI department will still be on the front line to assist with issues between clearinghouses. On a related note, on July 1, 2014, Blue Cross of Idaho launched a direct claim entry option through our secure provider portal to enter and submit CMS1500 claims to Blue Cross of Idaho. Thank you to all who have used our clearinghouse! We would like to remind you that as of April 1, 2014, we will only accept claims submitted on the revised CMS 1500 claim form (version 02/12). Claims received on older claim forms will be returned to you. 3

4 Pre-certification, Pre-authorization and Prior Approval for Blue Plans Online Our provider website, bcidaho.com/providers, has online pre-service tools such as pre-certification, pre-authorization and prior approval for out-of-area Blue Cross Blue Shield plans. To make service-specific eligibility and benefit inquiries, go to bcidaho.com/providers and select News & Resources, BlueCard Information, BlueCard Medical Policies, and finally General pre-certification/pre-authorization information. Providers may also use the medical policy router to review the out-of-state plan s general pre-service requirements by selecting Medical Policy. For pre-service reviews, select BlueCard Pre-Service Review for Out-of-Area Members Quick Links, and enter the out-of-area member s alpha prefix. The system will route you to the member s home plan s provider website to access pre-service review. If you have any questions, please contact your provider relations representative listed in Provider Administrative Policy 100. If you don t have access to Blue Cross of Idaho s secure provider portal, register by going to bcidaho.com and selecting Medical Providers, then Register Now, and then complete the required fields. Don t Forget 4

5 Don t Send Blue Cross of Idaho to the Spam Folder Many offices use spam filters to control incoming messages to avoid receiving possible viruses or unwanted solicitation. Others may use the filters to organize and prioritize messages. filtering may edit incoming s or simply pass messages to the user s mailbox, redirect messages for delivery elsewhere, or even throw messages away. Blue Cross of Idaho routinely communicates with providers via to convey important updates, respond to inquiries, and send notifications. Recently some provider office programs were moving our messages to junk folders or asking us to manually request to be added to an approved list. We strongly encourage all providers to add our address (or all@bcidaho.com addresses) to their safe senders list. A safe senders list sometimes called a whitelist is a list of approved contacts that stops spam filters from sending those s to the trash folder. Adding addresses to a whitelist varies across the different clients and internet security platforms, so ask your IT professional if you need assistance. Blue Cross of Idaho is Pleased to Announce Direct Claim Entry Blue Cross of Idaho is pleased to announce the implementation for Direct Claim Entry! This means with a userid and password for our website, bcidaho.com/providers, you will be able to bill your Blue Cross of Idaho professional medical claims direct. No software required! Please contact your External Provider Relations Representative to schedule training. Delays in New Provider Implementation and Existing Provider Updates Blue Cross of Idaho is experiencing a delay in the implementation of new provider packets and update requests to existing provider information. Please note that the backlog is approximately 8 to 12 weeks. You may check the online provider directory to see if you have been set up in our system or if your information has been updated. We are working diligently to get all of the paperwork processed and thank you for your patience. WELCOME BACK We are pleased to announce that Jennifer Hoppins has rejoined Blue Cross of Idaho as the Director of Dental and Provider Operations. As you may remember, during Jennifer s prior tenure at Blue Cross of Idaho, she oversaw Provider Relations, Provider Appeals and Provider Information Management. In Jennifer s new role, she has centralized oversight over Blue Cross of Idaho s Dental business and will work with executives to develop a multi-year business plan for dental services. This effort allows for the introduction of dental provider policies and procedures, efficiency measures, clinical & quality initiatives and operational improvements, all of which are intended to improve the customer experience as well as the overall value of our dental products within the market. Jennifer will represent Blue Cross of Idaho on the multi-state dental GRID board of directors and will serve as our executive contact for dental services with the BCBSA and with other Blue plans. Jennifer also directly oversees medical and dental Provider Credentialing, Provider Information Management and Provider Appeals. 5

6 New Faces My name is Jo Jackson and I am from Hot Springs, Arkansas. My husband is from Kuna so we chose to settle here after he retired from the military. I most recently worked as a credentialer at the Boise VA Medical Center and also bring experience from positions as a human resources assistant, patient services assistant, and pre-registration intake specialist. I am a distinguished graduate and veteran of the United States Air Force. I m a proud mama to a 13 year old and in my spare time I enjoy cooking, being outdoors, camping, hiking, riding my cruiser and BBQing. It s so great to be a part of the Blue Cross of Idaho team! Any Questions? Medical Management Managed Health Care/Review, Preadmission/Admission Certification, or Individual Benefits Management and Case Management n n n Voice mail available after office hours and on holidays and weekends Medicare Medicaid Coordinated Plan True Blue Dual Special Needs Plan Hours: n 8 a.m. - 9 p.m., MT seven days a week n Member Line Dual Special Needs Plan: n Waiver Providers Support Line: Blue Cross of Idaho Help Desk Electronic Billing Errors, Error and Acceptance Reports n 8 a.m. 5 p.m. MT (Monday Friday), n 888-BCI-EDIA, or Provider Contact Center for Commercial and Medicare Advantage Benefits, Coverage and Authorization n 8 a.m. 5 p.m. MT (Monday, Tuesday, Thursday, Friday) 8:30 a.m. 5 p.m. MT (Wednesday) n Commercial: or n Medicare Advantage: or Post-service claim questions log onto our secure website at bcidaho.com and select Contact Us. External Provider Relations Questions regarding website applications such as electronic billing, eligibility, claims, authorizations, internet services or requests for FREE on-site training n or Ext. 8309: Jamie Hunihan Treasure Valley West Ext. 8307: Kathy Brock, CPC-P North Idaho, WA, OR & MT Ext. 8308: Diane Mortensen, CPC South, Southcentral Idaho, NV Ext. 7032: Angeal McCormick Eastern Idaho, UT & NV 2014 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association 6