A publication to keep our network providers up to date on the latest news at 3rd Blue Quarter Cross 2013 and Blue Provider Shield of Network Louisiana News 3 4th Quarter 2011 networknews 1st Quarter 2016 provider providing health guidance and affordable access to quality care INSIDE THIS ISSUE Provider Network 2 Jill Taylor New to Network Development 2 Blue Cross Portal Browser Requirements 2 Requesting W-9s from Our Providers 2 Request for Medical Records for Risk Adjustment Process 3 BCBSLA Authorizations Application Enhancements 3 Professional Provider Workshops 4 Recredentialing Reminders Billing & Coding 4 Correct Use of HCPCS Level II Toe Modifiers 4 Specificity of Codes 4 Subcontracted Lab Providers 4 Claims Dispute Form 7 Drug Screening Assays 7 Reporting ICD-10 Qualifiers/ Indicators 7 Update Code Ranges 8 NDC on Claims 8 Child's Benefit from Annual Wellness Exam Medical Management 9 HEDIS: Avoidance of Antibiotics for Adults with Acute Bronchitis 10 Medical Policy Update Member Benefits 11 Healthier Generation Benefit 11 Diabetes Telemonitoring Provider Relations Representatives Provider Relations representatives are your point of contact within Blue Cross and Blue Shield of Louisiana when you need education on policy changes and the tools we offer. You may also contact your representative when you have an issue that cannot be resolved through ilinkblue or by Provider Services. Use our interactive Provider Representative Map available, online at www.bcbsla.com/ providers >Provider Tools, to find your area representatives. Simply scroll over your parish to find the desired contact information. Recently, we made changes to the Provider Relations representative areas of responsibility. Below is a list of each representative and the parishes they serve. Please check the list to see if your representative may have changed. Anna Granen - anna.granen@bcbsla.com - Jefferson, Orleans, Plaquemines, St. Bernard and St. Charles Jami Zachary - jami.zachary@bcbsla.com - Ascension, East Baton Rouge, East Feliciana, Livingston, St. Helena, St. Tammany, Tangipahoa and Washington Kelly Smith - kelly.smith@bcbsla.com - Acadia, Allen, Beauregard, Calcasieu, Cameron, Jefferson Davis, Sabine and Vernon Marie Davis - marie.davis@bcbsla.com - Avoyelles, Evangeline, Iberia, Lafayette, St. Martin, St. Landry and Vermillion Mary Guy - mary.guy@bcbsla.com - Assumption, Concordia, Iberville, Lafourche, Pointe Coupee, St. James, St. Mary, St. John the Baptist, Terrebonne, West Baton Rouge and West Feliciana Patricia O Gwynn - patricia.ogwynn@bcbsla.com - Bienville, Bossier, Caddo, Caldwell, Catahoula, Claiborne, Desoto, East Carroll, Franklin, Grant, Jackson, La Salle, Lincoln, Madison, Morehouse, Natchitoches, Ouachita, Rapides, Red River, Richland, Tensas, Union, Webster, West Carroll and Winn www.bcbsla.com/providers www.bcbsla.com/ilinkblue 23XX6753 R06/11 23XX6753 R03/16 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company.
2 Provider Network News 1st Quarter 2016 Provider Provider Network Network Jill Taylor New to Network Development We are pleased to announce Jill Taylor as the new Blue Cross Network Development representative for the New Orleans area, effective December 2015. Taylor comes to Blue Cross with 10 plus years of experience in provider relations and network contracting. A recent transplant from Lakeland, Florida, Taylor brings her technical knowledge of how to analyze market trends, proven negotiation skills and a desire to serve the New Orleans community with enthusiasm and attention to detail. Taylor spent most of her adult life in Lakeland, Florida; however, she was born and raised on the West Bank in St. Charles Parish and has strong family ties to the New Orleans area. She and her husband currently live in Kenner with their two sons. Blue Cross Portals Browser Requirements The supported browser for all Blue Cross portals is Internet Explorer. For Authorizations Portal users, if your organization is running IE 9 or above, you must run the application in Compatibility View. Other browsers such as Firefox, Chrome, etc., are not supported by Blue Cross. Authorizations Portal users with unsupported browsers may find features of the applications do not function appropriately, or the applications may fail to load. Requesting W-9s from Our Providers Please remember that you must submit a W-9 form along with your letter for network related changes such as TIN updates, address updates, recredentialing, etc. The IRS requires that we maintain updated W-9 forms for our network providers. Request for Medical Records for Risk Adjustment and HEDIS Processes Blue Cross, including HMO Louisiana, Inc., has partnered with Altegra* to perform risk adjustment and HEDIS chart reviews on our behalf. We have a confidentiality agreement with Altegra. Any information shared with Altegra will be kept in the strictest of confidence, in accordance with all applicable state and federal laws as well as HIPAA requirements regarding the confidentiality of patient records. Reviewing medical chart documentation is a key component of the risk adjustment and HEDIS processes. For example, it enables us to identify conditions that you may have noted in the progress notes, but were: Not included on the claim at the time of the visit Not coded to the highest degree of specificity at the time of the visit You are required to provide us with medical records as quickly as you can and without charge as outlined in your Blue Cross network agreement: Provider shall provide Blue Cross, upon request and without charge to Blue Cross or Member, information including medical records of a Member reasonably required by Blue Cross to determine benefits and verify services related to provider s attendance, examination, and/or treatment and allow Blue Cross onsite audit of such records. For questions about your network contract obligations, please contact Provider Relations at provider.relations@ bcbsla.com or 1-800-716-2299, option 4. *Altegra Health Company is an independent company that serves as a risk adjustment research manager for Blue Cross and HMO Louisiana. Get this newsletter emailed to you quarterly. Send an email to provider.communications@bcbsla.com. Put "newsletter" in the subject line.
1st Quarter 2016 Provider Network News 3 BCBSLA Authorizations Application Enhancements On April 4, 2016, we are enhancing our BCBSLA Authorizations application that is available under the Authorizations Portal section of ilinkblue. Utilizing your feedback, we have made improvements to the application that will help the authorization process become more efficient. There are six major changes that will be incorporated in this update. 1. One of the major updates will be the implementation of McKesson s InterQual clinical guidelines for providers to perform their clinical reviews. There will be three new InterQual Criteria icons in place of the Milliman icons. Clinical content criteria will be unavailable April 1-4 as we make the transition from Milliman to InterQual. Professional Provider Workshops To RSVP, please email: provider.relations@ bcbsla.com Put Provider Workshop in the subject line Please include the date and session time you plan to attend List all attendees by name and office name Please identify if the attendee is representing a billing/practice management company If unable to send an email, you may contact our Provider Relations department at 1-800-716-2299, option 4. 2. A new Attestation Page will display before you enter the application. It explains that if you are documenting sensitive information you must mark the note as sensitive, and the information entered does not replace your own Electronic Health Records. To continue to the application select the Yes button. 3. A new extension icon will now allow you to perform a concurrent review or extension of service. 4. There are new search criteria for when you are searching for a member. You may now use a member s Social Security number if the Subscriber ID is unavailable. 5. A confirmation page will display utilization management information, submitted request information and the automated decision after submission. 6. The Provider Supervisor Dashboard is an enhanced feature that will allow supervisors to reassign staff activities in the portal as needed. More details about these enhancements are available in the Authorizations Portal User Guide, located on ilinkblue under the Manuals section. An update guide will be posted mid-april. April 12, 2016 April 13, 2016 April 19, 2016 April 20, 2016 April 21, 2016 April 26, 2016 April 27, 2016 April 28, 2016 May 5, 2016 Baton Rouge Blue Cross 9 a.m. to noon or 1 to 4 p.m. Covington St. Tammany Parish Hospital 9 a.m. to noon Alexandria Pineville Convention Center 9 a.m. to noon West Monroe Hilton Garden Inn 9 a.m. to noon Bossier City Homewood Suites 9 a.m. to noon or 1 to 4 p.m. Thibodaux Thibodaux Regional 9 a.m. to noon Lake Charles Holiday Inn Suites 9 a.m. to noon Lafayette Wyndham Garden 9 a.m. to noon or 1 to 4 p.m. Metairie East Jefferson General Hospital 9 a.m. to noon or 1 to 4 p.m.
4 Provider Network News 1st Quarter 2016 CPT only copyright 2016 American Medical Association. All rights reserved. Provider Network Billing & Coding Recredentialing Reminders To streamline the recredentialing process, the necessary forms are now available online. This allows you to complete them in advance of your recredentialing date. It means we will no longer send providers a preprinted Recredentialing Application. Additionally, the Professional Liability Information Form can also be found online should you need to report case details on any professional liability action(s) incurred since your last credentialing approval with us. You will continue to receive a letter advising of your recredentialing deadline date. The recredentialing forms are available online at www.bcbsla.com/providers, then click on "Forms for Providers." Below are a few reminders to keep in mind when completing the recredentialing application as they will help expedite the recredentialing process. Use the most current Recredentialing Application Complete all fields that are applicable to you Include your Tax ID number Include the month and year in the education and work history sections The signature and date must be handwritten as Blue Cross does not accept signature stamps or date stamps Specificity of Codes Correct Use of HCPCS Level II Toe Modifiers Effective immediately, when billing toe or toenail surgeries, the following modifiers are necessary to ensure services are processed and paid correctly: Modifier TA Modifiers T1-T9 HCPCS Level II toe modifiers are anatomical and describe procedures performed on the right and left foot digits. Failure to use these modifiers appropriately may result in claims denial. It is incorrect to additionally append modifiers LT and/or RT. It is also incorrect to use Modifier 59 and/or Modifier 59 subset X modifiers (XE, XS, XP, XU). Additionally, post audits will be performed and will result in recoupments if documentation reviewed supports unbundling by incorrect use of Modifiers 59, XE, XS, XP, XU, LT and RT. Correction In our 4th quarter edition we incorrectly stated that Place of Service 22 for on-campus and offcampus services reimbursement will be based on office (non-facility) fees. This reference is only correct for Place of Service 19. Place of Service 22 is reimbursed based on nonoffice fees. We apologize for any inconvenience this error may have caused. It is important to file ALL applicable diagnosis codes (supported by the patient's medical records) on a claim. It is equally important that providers code claims to the highest degree of specificity. Blue Cross discourages providers from filing "not otherwise specified" (NOS) diagnosis codes. Claims with NOS codes may pend for medical record review and more appropriate coding. Subcontracted Laboratories Subcontracted laboratory services are those services furnished to patients by providers other than the facility while a patient is inpatient or outpatient. These services include the technical components of clinical and anatomical laboratory testing. The reimbursement outlined in the provider contract is intended to cover all hospital services rendered to a patient, including those services that are performed by subcontracted laboratories. Subcontracted laboratories must seek payment solely from the facility. Subcontracted laboratories cannot bill Blue Cross or the member for such services. This is a violation of the contract agreement with Blue Cross. Full information is included in our Member Provider Policy & Procedures Manual available on ilinkblue (www.bcbsla.com/ilinkblue) under the "Manuals" section. Claims Dispute Form Our new Claims Dispute Form has replaced the Reimbursement Review Form. This form is available online now for use for when you have a claims dispute. Effective June 1, 2016, we will no longer accept the current Reimbursement Review Form. You may cut out the new form located on the next two pages. The form is available at www.bcbsla.com/ providers, then click on "Forms for Providers."
1st Quarter 2016 Provider Network News 5 Claims Dispute Form Use this form to dispute a claim. This form must be included with your request to ensure that it is routed to the appropriate area of the company, thus avoiding delays in our review process. It is important to return the proper information (based on your reason for review) and that it is sent to the appropriate mailing address. Please submit only one form per patient, per dispute. PROVIDER INFORMATION TYPE OF PROVIDER: Professional Facility Other: PROVIDER NAME NATIONAL PROVIDER IDENTIFIER (NPI) PERSON COMPLETING THIS FORM PROVIDER TAX ID CONTACT PHONE NUMBER CONTACT EMAIL ADDRESS PATIENT INFORMATION MEMBER ID NUMBER PATIENT NAME POLICYHOLDER NAME PATIENT DATE OF BIRTH CLAIM NUMBER DATE(S) OF SERVICE AMOUNT CHARGED GUIDE FOR SUBMITTING SUPPORTING DOCUMENTATION SURGERY, ASSISTANT SURGERY or ANESTHESIA DOCTOR S HOSPITAL VISITS DOCTOR S OFFICE/CLINIC VISITS OTHER SERVICE X-RAYS, LAB, PHYSICAL THERAPY 1) Operative Report 2) Anesthesia Report 3) Pre-Op History and Physical 4) Asst. Surgeon Credentials (If Not M.D.) 1) Discharge Summary 2) Hospital Progressive Notes 3) History and Physical Notes 4) Pathology Report 1) Office Notes Pertaining to Date of Service 2) History and Physical Notes 1) Physical Therapy Notes and Radiology/Lab Report Page two of this form contains the list of reasons for your claims dispute. Please check only one reason per form. In order for us to review your claim dispute, we must receive the entire form. A printable PDF of this form is available online at www.bcbsla.com/providers, then click on Forms for Providers. (dispute reasons on next page) 18N2284 03/16 Page 1 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company. Last reviewed on March 16, 2016.
6 Provider Network News 1st Quarter 2016 Claims Dispute Form PLEASE REVIEW MY CLAIM FOR THE FOLLOWING REASON (Check only one reason per form) REASON FOR REVIEW MUST INCLUDE TIME TO ALLOW FROM DATE SUBMITTED WHERE TO SEND Claim rejected as duplicate Claim denied for bundling Supporting medical documentation Reason why current bundling logic is incorrect 30 days ELECTRONICALLY: 14 days Submit an action request through ilinkblue: (www.bcbsla.com/ilinkblue) Supporting medical documentation HARDCOPY: BCBSLA P.O. Box 98029 Baton Rouge, LA 70898-9029 Claim denied for medical records Copy of our letter of request for medical records Supporting medical documentation 14 days HARDCOPY: BCBSLA Medical Records P.O. Box 98031 Baton Rouge, LA 70898-9031 Claim denied as investigational or not medically necessary Claim payment/denial affects the provider s reimbursement Timely filing Reimbursement Authorization penalty Other Claim payment affects the member s cost share (deductible, coinsurance, copayment) Formal letter of appeal including reason Supporting medical documentation Formal letter of dispute including reason Supporting medical documentation Proof of timely filing (only if denied for timely filing) Formal letter of appeal including reason Supporting medical documentation (must include authorization from the member) 30 days HARDCOPY: BCBSLA MEDICAL APPEALS P.O. Box 98022 Baton Rouge, LA 70898-9022 or FAX: 225-298-1837 60 days HARDCOPY: BCBSLA Appeals and Grievances P.O. Box 98045 Baton Rouge, LA 70898-9045 30 days 18N2284 03/16 Page 2 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company. Last reviewed on March 16, 2016.
CPT only copyright 2016 American Medical Association. All rights reserved. 1st Quarter 2016 Provider Network News 7 Billing & Coding Drug Screening Assays Recently we made changes to our Drug Screening Assays policy. Effective January 1, 2016, we only accept claims with CPT drug screen codes. Presumptive drug screening: Blue Cross will only allow payment for one presumptive drug screen for drugs from Drug Class A and/or B (CPT codes 80300-80304) regardless of the number of services performed. Definitive drug testing: For dates of service on or after January 1, 2016, Blue Cross requires that claims be filed using CPT codes 80300-80377 rather than the temporary Medicare HCPCS codes G0477-G0483. Claims filed with HCPCS codes G0477-G0483 will be denied and must be refiled with current CPT codes. Reporting ICD Qualifiers/ Indicators Covered entities under HIPAA are required to report the ICD qualifier/ indicator on all claim submissions. Claims submitted without the qualifier or with an incorrect value will be returned. Follow these important points when submitting claims: Report the ICD qualifier/indicator in Form Locator 66 of the UB-04 Report the ICD qualifier/indicator in Box 21 of the CMS-1500 claim form Use ICD qualifier "9"to report ICD-9 coded claims Use ICD qualifier "0" to report ICD-10 coded claims Note: ICD-9 and ICD-10 codes cannot be reported on the same claim. Updated Code Ranges We recently completed a review of new 2016 CPT and HCPCS codes. As a result, we made minor updates to the Diagnostic and Therapeutic Services code ranges. The following HCPCS code(s) have been added to the Outpatient Procedure Services code list effective January 1, 2016: 10035-10036 31652-31654 33477 37252-37253 39401-39402 43210 47531-47544 49185 50430-50435 50606 50693-50695 50705-50706 54437-54438 61645 61650-61651 64461-64463 65785 69209 0396T 0397T 0404T 0406T-0416T 0419T-0436T The following HCPCS codes have been added to the Diagnostic and Therapeutic Services code range and the Outpatient Hospital Drug list effective January 1, 2016. 72081-72084 73501-73503 73521-73523 73551-73552 74712-74713 77767-77772 78265-78266 80081 81162 81170 81218-81219 81272-81273 81276 81311 81314 81412 81432-81434 81493 81525 81528 81535-81536 81538 81540 81545 81595 88350 90625 92537 92538 93050 96931-96936 99177 0394T-0395T 0398T-0402T 0417T-0418T 0422T-0423T A4337 C1822 C2645 C9458-C9460 G0297 G0299-G0300 G0475-G0483 J0202 J0596 J0695 J0714 J0875 J1443 J1447 J1575 J1833 J2407 J2502 J2547 J2860 J3090 J3380 J7121 J7188 J7205 J7297 J7298 J7313 J7328 J7340 J7503 J7512 J7999 J8655 J9032 J9039 J9271 J9299 J9308 P9070-P9072 Q4161-Q4165 Q9950 Q9980 These changes do not affect existing codes and allowable charges on the Diagnostic and Therapeutic Services schedules. It simply allows our system to accept these codes appropriately for claims adjudication. The above changes also apply to the HMO Louisiana, Inc. Diagnostic and Therapeutic Services schedule. The complete lists of the Outpatient Procedure Services and Diagnostic and Therapeutic Services are in the Member Provider Policy & Procedures Manual, available on ilinkblue (www.bcbsla.com/ilinkblue) under the "Manuals" section. We help Louisianians protect every day.
8 Provider Network News 1st Quarter 2016 CPT only copyright 2016 American Medical Association. All rights reserved. Billing & Coding NDC on Claims Effective July 1, 2016, we require all drugs billed on medical claims to be processed through the member s medical benefits must include an NDC. Failure to report an NDC on these claims will result in automatic denials. For Hardcopy Claims On the CMS-1500 claim form, report the NDC in the shaded area of Box 24A (the NDC is to be preceded with the qualifier N4 and followed immediately by the 11 digit NDC code, e.g. N499999999999) On the UB-04 claim form, report the NDC in Box 43 (description field) For Electronic Claims Report the NDC in loop 2410, Segment LIN03. The code should consist of the CMS 11-digit NDC derivative with a leading zero resulting in a fixed length 5-4-2 (no hyphens) configuration. The proper format is validated during the processing period. The drug pricing information along with the corresponding unit(s) of measure should be reported in loop 2410 CTP03-05. Available measures of units include the international unit, gram, milliliter and unit. For ilinkblue Claims Select 24K to expand claim line to report NDC, Quantity, and Measurement. Reporting NDCs on claims improves accuracy, especially for claims filed using the miscellaneous HCPCS code J3490. Having NDCs improves claims adjudication and provides us with better data for our members. Child's Benefit from Annual Wellness Exam An annual wellness visit is especially important for children, to check their physical, emotional and social development and make sure they are meeting the right age milestones. The following codes can be used for children's annual wellness visits: E&M Codes for Well-Child Visits 99382 - new patient, preventative visit, age 1 through 4 years 99383 - new patient, preventative visit, age 5 through 11 years 99392 - established patient, preventative visit, age 1 through 4 years 99393 - established patient, preventative visit, age 5 through 11 years ICD-10 Codes for Well-Child Visits, as appropriate Z00.121 - encounter for routine child health examination with abnormal findings Z00.129 - encounter for routine child health examination without abnormal findings Z00.8 -encounter for other general examination Submitting the well-child and sick-child visit on the same claim: You can bill for a preventative evaluation and management (E&M) service (well-child visit) and a problem-oriented E&M service (sick visit) on the same day and be reimbursed for both by filing the well-child CPT code and the sick-visit CPT code with Modifier 25. CPT guidelines state, "The abnormality or pre-existing problem found during the preventative exam must be significant enough to require additional work to perform all the components of the problem-oriented E&M service." The well-child visit must occur with a primary care physician or pediatrician. Medical records must have documentation to justify both services. In addition, please file all the appropriate diagnosis codes as applicable for all services performed during the well/sick child visit. If your patients want more information about why a yearly checkup with a primary care doctor is important for their overall health, they can visit www.bcbsla.com/pcp.
1st Quarter 2016 Provider Network News 9 Medical Management HEDIS: Avoidance of Antibiotics for Adults with Acute Bronchitis Do I need an antibiotic? How many times have you heard your patients presenting with symptoms of acute bronchitis or the common cold, ask this question? In today s world, where everyone is looking for instant gratification, and in healthcare, instant relief via a quick cure, the patient s expectation of receiving antibiotics poses a challenge for physicians. According to the Centers for Disease Control and Prevention, antibiotic resistance is one of the world s major public health challenges. Inappropriate use of antibiotics is the single most important factor in antibiotic resistance. An example of antibiotic misuse is the inappropriate prescribing of antibiotics for treating acute bronchitis in adults. Avoidance of antibiotic treatment in adults with acute bronchitis (AAB) is a Healthcare Effectiveness Data Information Set (HEDIS) measure that assesses patient care and services specifically for this issue with the overall goal being to NOT prescribe antibiotics for patients 18-64 years of age with a diagnosis of acute bronchitis without a competing diagnosis or co-morbidity. A cough is the most common symptom bringing patients in to see their primary care physician with acute bronchitis being the most common diagnosis. About 90 percent of the time, acute bronchitis is caused by a virus and antibiotics are not warranted. Many patients receiving this diagnosis expect medications for symptom relief, and physicians are tasked with convincing patients that an antibiotic is not the right course of treatment. The challenge becomes managing the patient s expectation of receiving a prescription for an antibiotic. Although 90 percent of bronchitis infections are caused by viruses, approximately two thirds of patients in the United States diagnosed are inappropriately treated with antibiotics. Because of the risk of antibiotic resistance and potential adverse effects such as rashes, yeast infections, and Clostridium difficile infections, antibiotics should not be routinely used in the treatment of acute bronchitis. Patient education and effective communication are vital in overcoming the challenge of managing the patient with acute bronchitis thus helping to reduce inappropriate antibiotic prescribing. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Sources: www.ncqa.org www.qualitycompass.com Educating patients that antibiotics do not significantly reduce the duration of symptoms and may cause more harm than good may be helpful in reducing the expectation of an antibiotic prescription. Careful word selection such as defining the diagnosis as a chest cold or viral upper respiratory infection along with offering at home treatments can also be helpful. In addition, setting realistic expectations for symptom duration (cough may last about three weeks) gives the patient a better understanding of the disease process. Education and communication are important in managing patient expectations for medications to treat acute bronchitis symptoms. Please share the information in this newsletter with your billing office and those at your office who work with Blue Cross reimbursement.
10 Provider Network News 1st Quarter 2016 Medical Management Medical Policy Update Blue Cross regularly develops and revises medical policies in response to rapidly changing medical technology. Our commitment is to update the provider community as medical policies are adopted and/or revised. Benefit determinations are made based on the medical policy in effect at the time of the provision of services. Please view the following updated medical policies, all of which can be found on ilinkblue at www.bcbsla.com/ilinkblue. New Medical Policies Policy No. Policy Name Effective December 16, 2015 00484 I Focal Treatments for Prostate Cancer 00486 I Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia 00444 I Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/ Hyperactivity Disorder 00478 C Treatment of Hepatitis C with ombitasvir, paritaprevir, and ritonavir (Technivie TM ) 00472 C Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Inhibitors [alirocumab (Praluent ), evolocumab (Repatha )] 00479 C I Treatment of Hepatitis C with daclatasvir (Daklinza ) plus sofosbuvir (Sovaldi ) Effective January 22, 2016 00489 C Mutation Testing for Limb-Girdle Muscular Dystrophies 00490 I Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management 00498 I Multispectral Digital Skin Lesion Analysis Effective February 17, 2016 00487 C insulin degludec (Tresiba ) 00493 I Adipose-derived Stem Cells in Autologous Fat Grafting to the Breast 00494 C Transcatheter Mitral Valve Repair 00499 C asfotase alfa (Strensiq ) 00500 C aspirin extended release capsules (Durlaza ) 00501 C mepolizumab (Nucala ) Medical Policy Coverage Legend These symbols are referenced next to medical policies listed on this page and indicate Blue Cross coverage indications as follows: I C N Investigational Eligible for coverage with medical criteria Not medically necessary Recently Updated Medical Policies Policy No. Policy Name Changes Effective December 16, 2015 00006 C Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions 00008 C Automatic Implantable Cardioverter Defibrillator (AICD) 00070 C Hyperbaric Oxygen Pressurization (HBO) 00098 C Dermatologic Applications of Photodynamic Therapy 00225 C adalimumab (Humira ) 00260 C Spinal Cord Stimulation 00397 C Treatment of Hepatits C with a sofosbuvir (Sovaldi ) Based Regimen 00455 C Treatment of Hepatitis C with sofosbuvir/ledipasvir (Harvoni ) Changes Effective January 22, 2016 00034 C Treatment of Varicose Veins/Venous Insufficiency 00170 C Immune Globulin Therapy 00261 C Endoscopic Radiofrequency Ablation or Cryoablation for Barrett's Esophagus 00408 C Genetic Testing for Cardiac Ion Channelopathies 00459 C Genetic Testing for FLT3, NPM1, and CEBPA Mutations in Acute Myeloid Leukemia Change Effective February 17, 2016 00012 C Botulinum Toxins 00045 C Stereotactic Radiosurgery and Stereotactic Body Radiotherapy 00169 C Cytochrome p450 Genotyping 00228 C Intradialytic Parenteral Nutrition 00243 C Iomitapide (Juxtapid ) 00248 I Adoptive Immunotherapy 00292 C Sinus Ostial Dilatation with Balloon Catheter for Chronic Rhinosinusitis 00344 C Tropical Acne Kits 00345 C Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-free Fetal DNA 00349 C mipomersen (Kynamro ) 00488 C Identification of Microorganism Using Nucleic Acid Probes Change Effective February 20, 2016 00104 C Positron Emission Tomography (PET) Miscellaneous (Noncardiac, Non-oncologic) Applications Provider inquiries for reconsideration of medical policy coverage, eligibility guidelines or investigational status determinations will be reviewed upon written request. Requests for reconsideration must be accompanied by peer-reviewed, scientific evidence-based literature that substantiates why a technology referenced in an established medical policy should be reviewed. Supporting data will be reviewed in accordance with medical policy assessment criteria. If you have questions about our medical policies or if you would like to receive a copy of a specific policy, log on to ilinkblue at www.bcbsla.com/ilinkblue or call Provider Services at (800) 922-8866.
1st Quarter 2016 Provider Network News 11 BlueCard Member Program Benefits Healthier Generation Benefit In Louisiana, 39.8% of middle school and high schoolaged children are obese, considerably more than the national average of 31.3%. As a provider, you now have more resources for helping some of these children in your care. Blue Cross has partnered with the Alliance for a Healthier Generation to increase awareness about a benefit for children who are diagnosed overweight or obese. This benefit is available for: Children ages 3 to 18 who are diagnosed as overweight or obese and covered under some policies. They are allowed at least four primary care physician visits and at least four registered dietitian visits as contract benefits. Additionally, children ages 6 to 18 diagnosed with obesity and covered under some policies. These kids are fully covered for six months of intensive, comprehensive treatment. The six-month coverage begins when the child is diagnosed with obesity at his or her annual wellness visit. Treatment such as individual and group health-oriented counseling, eligible weight management classes and health and behavior interventions are included in the benefit. According to the 2015 State of Obesity report, Louisiana ranks fourth of the 51 states/territories for obesity in children ages 10-17. Louisiana has consistently received an F grade for childhood overweight and obesity in the Louisiana Report Card on Physical Activity & Health for Children and Youth. We must work together to fight childhood obesity. We at Blue Cross urge you to tell your patients with Blue Cross coverage that children diagnosed as obese may be eligible for more help. Blue Cross customers can contact the toll-free customer service phone number on their ID cards for details on what is covered under their plans. Diabetes Telemonitoring In November 2015, we partnered with Genesis Health Technology (GHT) to offer Diabetes Telemonitoring to our members. All of our members are eligible to take advantage of this program except Federal Employee Program (FEP), Blue Advantage and Office of Group Benefits (OGB). Diabetes Telemonitoring involves remotely monitoring diabetic members who are not at the same location as the healthcare provider. This method allows members to track their blood glucose at home and automatically uploads a member s test results over a cellular network to a secure, online web portal accessed by the healthcare provider. When a member s glucose readings are out of range, a nurse will contact them. The provider can view their members individual glucose readings via secure web portal. Benefits of Telemonitoring Accurate, real-time blood glucose data transmission Online access to blood glucose test results with the ability to print reports Ability to share test results with healthcare professionals For more information or to refer your patients to the program: GHT Customer Service Phone: 1-888-263-0003 GHT Website: www.genesishealthtechnologies.com STAY CONNECTED WITH US Visit BCBSLA's Provider Page: www.bcbsla.com/providers Connect with us on Facebook: www.facebook.com/bluecrossla Follow BCBCLA on Twitter: www.twitter.com/bcbsla Watch us on YouTube: www.youtube.com/bluecrossla
networknews P. O. BOX 98029 BATON ROUGE, LA 70898-9029 PRST STD US POSTAGE PAID BATON ROUGE, LA PERMIT NO. 458 What's New on the Web www.bcbsla.com/providers NEW Claims Dispute Form is available under the Forms for Providers section NEW Credentialing/Recredentialing forms are available under the Forms for Providers section Network News Network News is a quarterly newsletter for Blue Cross and Blue Shield of Louisiana network providers. We encourage you to share this newsletter with your staff. The content in this newsletter is for informational purposes only. Diagnosis, treatment recommendations and the provision of medical care services for Blue Cross members are the responsibilities of healthcare professionals and facility providers. Important Contact Information Authorization See member's ID card BlueCard Eligibility (800) 676-BLUE (800-676-2583) EDI Clearinghouse (225) 291-4334 EDICH@bcbsla.com FEP (800) 272-3029 Fraud & Abuse (800) 392-9249 Fraud@bcbsla.com ilinkblue & EFT (800) 216-BLUE (800-216-2583) ilinkblue.providerinfo@bcbsla.com Network Administration (800) 716-2299 Fax: (225) 297-2750 Network.Administration@bcbsla.com Provider Services Call Center (800) 922-8866 Claims Filing Address P.O. Box 98029 Baton Rouge, LA 70898 View this newsletter online at www.bcbsla.com/providers, then click on News. Get This Newsletter Electronically Your correspondence email address allows us to electronically keep you abreast of the latest Blue Cross news and some communications that are sent via email only. Email provider. communications@bcbsla.com and please include a contact name, phone number and your provider number in your email. Please share this newsletter with your insurance and billing staff!