BCBSTX Bridges to Excellence Inflammatory Bowel Disease (IBD) Care Program Guide
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1 BCBSTX Bridges to Excellence Inflammatory Bowel Disease (IBD) Care Program Guide Blue Cross and Blue Shield of Texas (BCBSTX) is pleased to offer an innovative program that recognizes Texas physicians who deliver excellent care to patients diagnosed with Inflammatory Bowel Disease (IBD). As a sponsor of the Health Care Incentives Improvement Institute (HCI3, formerly Bridges to Excellence [BTE]) organization and their Inflammatory Bowel Disease (IBD) Care Recognition program, BCBSTX demonstrates our commitment to making health and wellness a priority for our members. This program financially rewards network physicians for their performance and their Inflammatory Bowel Care recognition status. Goals of the Inflammatory Bowel Disease (IBD) Program Improve patient outcomes and their quality of life Financially reward physicians who provide excellent care to members with inflammatory bowel Reduce the economic burden of caring for members with inflammatory bowel Link into other established Blue Care Connection medical and dental programs that interact directly with members to improve their health and disease condition BCBSTX Inflammatory Bowel Program Model There are two steps to take in order to participate in this incentive program. Step One: Become a BTE recognized inflammatory bowel care provider. Although BCBSTX provides guidance and instruction, this first step is between the physician and the BTE organization.
2 BTE collects specific data from your medical records for patients with inflammatory bowel. This data is scored by MedConcert, a performance assessment organization (PAO). A score of 60 out of 100 allows a physician to become recognized for inflammatory bowel care. There are two pathway options for submitting the data to be scored. Option One: Have your EMR vendor pull the data and submit it for scoring. You have this option if you use one of the following EMR providers that partners with BTE: Athena Health, eclinicalworks, MediTab, Meridios or NextGen. The EMR will submit data for all of your patients with inflammatory bowel who meet the program parameters. Contact the person listed below for your EMR vendor to proceed with this option. EMR Vendor Athena Health eclinicalworks Contact Alexis Isabelle bte@athenahealth.com incentiveprograms@eclinicalworks.com MediTab info@meditab.com Meridios info@meridios.com NextGen Cindy Jeffords cjeffords@nextgen.com Option Two: Submit data directly on the bte.medconcert.com website. For this option you take a random sample of 25 records of your patients with inflammatory bowel and enter the requested data at bte.medconcert.com. There is a fee of $145 for an individual physician or $395 for a group of 3 20 physicians. Instructions for Option Two: 1. Go to bte.medconcert.com (there is no www at the beginning) and click Get Started. 2. Click Get Started again if you have never logged on before. Otherwise log in. 3. Answer the questions to obtain a User ID and Password. 4. Once you are logged in to MedConcert (you are not at the BTE part of the website yet), click on the Apps tab at the top of the page. 5. On the Apps page choose Bridges to Excellence from the alphabetical list. Once you have selected the BTE app, BTE information will be on your home page for future log-ins. 6. At this point start with the instructions from the User Guide by clicking here. Print these instructions for easy reference.
3 7. If you encounter technical questions or problems while entering your BTE information, send an to Please include the following information in your a. Your Name, b. Physician s Name, c. Physician s NPI, d. Address, e. Phone Number, f. User Name for the bte.medconcert.com website and g. Describe the problem you are experiencing. The technical team is good about quickly responding to your questions. You will submit data from patients who: Are between ages 18 and 75 That you have seen for inflammatory bowel for at least one year From ALL insurance populations
4 BTE Inflammatory Bowel Care Recognition Program Measures, Performance Criteria and Scoring Performance Assessment Organizations (PAOs) award recognition to clinicians who achieve at least 60 points. Inflammatory Bowel Recognition Clinical Measures Total Possible Points IBD Type, Anatomic Location, Disease 15 Activity IBD External Manifestations Assessed 10 Corticosteroid-Sparing Therapy Prescribed 10 Bone Loss Assessment for Patients Receiving 7.5 Corticosteroid Therapy Osteoporosis Therapy in Patients with Bone 2.5 Loss Testing for Latent TB before Initiating anti-tnf 10 Therapy Assessment of Hepatitis B Virus Before 10 Initiating anti-tnf Therapy Influenza Immunization 7.5 Pneumococcal Immunization 7.5 Tobacco Screening 5 Tobacco Cessation Counseling 5 Appropriate Use of Surveillance Colonoscopy for Prevention of Colorectal Cancer 10 Depression Screening 0 Use of Biologics 0 Step Two: Participate in the BCBSTX incentive program After a physician achieves recognition, he/she is automatically included in the BCBSTX incentive program BCBSTX obtains Bridges to Excellence recognized provider list from HCI3 each month BCBSTX attributes Blue Cross and Blue Shield of Texas members with inflammatory bowel to their BTE recognized physicians BCBSTX loads the patient information on and mails User Name and Password to first time portal users
5 Physician logs in to portal, enters and submits biometric information Authorization to file claims is produced on portal once biometric information is submitted Physician files claims on the approved patients. BCBSTX pays the incentive through the claims payment system An explanation of these steps is provided below. Attribution is the process of linking a member to a physician for this program. A member is attributed to a physician every 12 months. How are BCBSTX members attributed to physicians? Members: Must have a Texas address A diagnosis code from Appendix A Must be 5 years of age or older Must have at least one inpatient claim or one face-to-face visit in the last 15 months Must be a Blue Cross and Blue Shield of Texas PPO/POS, HMO member Program excludes Blue Card (BCBS members from other states), FEP, Medicaid, Retail Exchange, Blue Advantage and Medicare eligible members Physicians: Must be an MD or DO and non-hospital Based Must have at least one face to face claim with E&M code If member sees multiple providers, then the following hierarchy will apply o If there are multiple providers, then greatest number of claim service dates determines selection o If still multiple providers, then most recent service date claim o If still multiple providers, then select the provider with the largest total allowed dollars o If still multiple providers, select the provider using the highest provider ID Biometrics requested by BCBSTX Type of Inflammatory Bowel Disease (IBD) Medication/Treatment Specialty or Modified Diet Influenza Immunization To receive the incentive payment for a patient all questions must be answered during the 12 months prior to the attribution date stated on the form up to three months after the attribution date. Filing claims for incentive payment Incentive money is paid through the normal claim filing system file these claims to BCBSTX as you would any other claim. Instructions are provided with the authorizations including:
6 Use the authorization date provided as the Date of Service (DOS) on the claim. This date does not represent a visit to your office, it matches the date in our system for a BTE claim. Use CPT code on the claim. BCBSTX uses this code for BTE payments. Use patient s IBD ICD-10 code from your medical records Amount billed is $ Only file this one service line on BTE claims Timely claim filing rules apply to these claims which is one year from the DOS provided. BCBSTX BTE Incentive Program Good to Know Your first patient list will be available on toward the end of the month two to months following your recognition month New patients are posted on the portal every six months Incentives are paid per patient per year Contact Information Most questions can be answered at BCBSTX Anita Ward, RN Program Specialist bridges_to_excellence@bcbstx.com Phone: Fax: Technical issues for bte.medconcert.com at support@medconcert.com and include in your Name Clinician Name Clinician NPI User Name for bte.medconcert.com address Phone # Problem you are experiencing Questions for the BTE organization at HCI3 Jeremy Faulkenburg, Program Implementation Leader jeremy.faulkenburg@hci3.org Phone:
7 Appendix A ICD10 Codes K5000, K50011, K50012, K50013, K50014, K50018, K50019, K5010, K50111, K50112, K50113, K50114, K50118, K50119, K5080, K50811, K50812, K50813, K50814, K50818, K50819, K5090, K50911, K50912, K50913, K50914, K50918, K50919, K5100, K51011, K51012, K51013, K51014, K51018, K51019, K5120, K51211, K51212, K51213, K51214, K51218, K51219, K5130, K51311, K51312, K51313, K51314, K51318, K51319, K5140, K51411, K51412, K51413, K51414, K51418, K51419, K5150, K51511, K51512, K51513, K51514, K51518, K51519, K5180, K51811, K51812, K51813, K51814, K51818, K51819, K5190, K51911, K51912, K51913, K51914, K51918, K51919 AND One of the following patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99406, 99407
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