Recognizing Physician Excellence SM Program

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1 Recognizing Physician Excellence SM Program Guide to Physician Tools and Resources SU

2 Recognizing Physician Excellence (RPE) Program Guide to Physician Tools and Resources Table of Contents Introduction Physician Programs 1. emedicine 2. eprescribing 3. Availity CareProfile 4. CareCalc 5. Availity Health Information Network 6. Health Dialog 7. Disease Management 8. Diagnostic Imaging Guidelines 9. Preventive Screening Criteria 10. Decision Support Tools 11. CAHPS Satisfaction Survey Questions

3 Introduction Welcome to the Recognizing Physician Excellence program Guide to Physician Tools and Resources. This guide directs you to information about the Blueprint for Health programs that are available to you, our valued physicians, and our members. Blueprint for Health is Blue Cross and Blue Shield of Florida s (BCBSF s) wholeperson approach to integrated care and service. It includes programs and service solutions for: Prevention and wellness Decision support tools Chronic and acute condition support Health care provider support On the following pages, you will find both physician and member program summaries and links to websites that provide comprehensive program information. As a member of BCBSF s RPE program, you play an important role in serving our members. We appreciate your commitment to quality care and excellent service and thank you for participating in the RPE program

4 Physician Programs 1. Secure Connectivity (emedicine) emedicine offers an alternative to an office visit. For members who prefer using the Internet to access health care information, e-medicine is perfect. It saves time and can reduce work absenteeism. Using e-medicine, a new prescription can be filled, lab results can be shared, and an appointment with a doctor or a referral can be made. e-medicine is a safe and confidential way to communicate about non-urgent health care needs. It's as easy to use as and incorporates security measures that ensure patient privacy. For more information click on the link below:

5 2. eprescribing eprescribing provides the capability to write and transmit prescriptions electronically. A physician may also view drug formularies and comprehensive drug reference information as well as patient medication history. For more information click here

6 3. Availity 1 CareProfile The Availity Care Profile is a secure, electronic record that provides a history of a patient s health care services no matter which doctor, hospital or other provider (such as a lab or pharmacy) rendered the service that was submitted to BCBSF for payment or which health plan the patient was covered under at the time. With this consolidated record, physicians have a more thorough picture of a patient s medical history. This supports improved delivery of care to the patient, more informed health care decisions and a better health care experience for the patient. For more information: 1. Log on to Availity, 2. Click on Products and Services 3. Click on Health Records 1 Availity, L.L.C., is a multi-payer, joint venture company. For more information, or to register, please visit Availity's website at

7 4. CareCalc CareCalc enables physician office staff to calculate the patient s financial responsibility at any time during the service, starting with scheduling the appointment through the completion of an office visit. For more information click on the link below:

8 5. Availity Health Information Network Using a secure online gateway, the Availity Health Information Network optimizes the flow of information between physicians, health plans, pharmacies and other health care providers. Through the Availity Health Information Network providers can: Check eligibility and benefits Submit claims Check claims status Request a Health Care Service Review (precertification, authorizations and referrals) Receive an Electronic Remittance Advice Availity offers a HIPAA-AS compliant, fast and efficient way to exchange information and conduct health care transactions that reduce health care costs, simplify provider workflows, and improve the patient experience. For more information: 1. Log on to Availity, 2. Click on Products and Services 3. Click on Demonstration

9 6. Health Dialog In 2002, BCBSF contracted with Health Dialog, a resource for health information, to help members incorporate their personal values and preferences into their health care choices. Health Dialog provides a whole person approach to chronic condition management and decision support to assist our members with better managing their health decisions and effectively communicating with their doctors regarding treatment options. Health Dialog can help you educate your patients and provides a source for answers to their questions about chronic diseases such as asthma, CAD, CHF, COPD, diabetes, hypertension and others. As one of our valued RPE program physicians, you have the opportunity to refer our chronically ill members directly to Health Dialog for the six chronic diseases described above. For more information click on the link below: Click here for the Health Dialog Referral Form As a courtesy, BCBSF has entered into arrangements with various vendors to provide value-added features that include care decision support tools and services to its members. These programs are not part of insurance coverage. All decisions should be made in conjunction with the physician, since neither BCBSF nor its vendors provide medical care or advice

10 7. Disease Management The Disease Management program offers proactive personalized support services for health care management. The program is designed to help members cope with pain, prevent complications and deal with the emotional challenges of a long-term, complex condition. Targeted outreach, decision support, health coaching, education and customized care plans help enhance the quality and experience of care our members receive. For more information click on the link below: For the Case Management Referral Form:

11 8. Diagnostic Imaging Guidelines BCBSF contracts with National Imaging Associates, Inc., (NIA) to provide imaging guidelines via their website link included below. Treatment decisions remain solely the decision of qualified medical personnel. The guidelines are provided for informational purposes only. For more information on authorizations click on the link below: Click here for fast tracker:

12 9. Prevention Screening Criteria The RPE program measures the care and quality of both preventive screenings and care of chronic conditions. This is your direct link to the latest clinical recommendations made by the U.S. Preventive Services Task Force (USPSTF). Blue Cross and Blue Shield of Florida, Inc. and Health Options, Inc. have adopted the USPSTF s Guide to Clinical Preventive Services for adults and children. Preventive Services

13 10. Decision Support Tools The Healthcare Advisor SM can assist physicians and members research medical conditions or procedures, review physician education, training, affiliations and certifications, conduct side-by-side comparison on area hospitals based on quality and risk-adjusted data, and view estimates for the cost of specific health care services. The tools are also available in Spanish. For more information: 1. Log into using the Registered User s Login 2. Click on Payer Resources at the top of the page 3. Under Payer Resources select BCBSF 4. Under Tools select Researching a Physician 5. Select: Healthcare Advisor Physician Advisor Hospital Advisor Treatment Cost Advisor

14 11. CAHPS Satisfaction Survey Questions The Consumer Assessment of Health Plan Survey (CAHPS) measures member satisfaction with services provided by their doctors and health plans. The annual survey covers aspects such as the ability to get needed care, the ability to get care quickly and how well doctors communicate. For more information click on the link below:

15 Fax to: (800) Health Dialog Referral Form If you would like a Health Dialog coach to call a member to encourage them to follow your treatment plan and provide them with disease management information, complete this form and fax it to (800) Patient Information Patient Last Name Patient First Name Member ID Number (alpha prefix and numbers) Patient Date of Birth Gender Male Female Street Address City State Zip Telephone Number ( ) Reason for Referral: Physician Name: Provider Number:

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