Member PCP and Specialists Appointment Call Campaign. PO Box 7408 Boise, Idaho Tel Health and wellness or prevention information

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1 Provider Newsletter SPRING Edition Member PCP and Specialists Appointment Call Campaign Blue Cross of Idaho has partnered with Optum again this year to conduct our Member PCP and Specialists Appointment Call Campaign. Below is some information that will help your office understand the campaign and how it may impact you. Why has Blue Cross of Idaho implemented this campaign? Blue Cross of Idaho has implemented this call campaign to bring awareness to targeted members about their healthcare benefits for wellness visits and preventive care screenings, as well as to help facilitate referrals and/or appointments for these servcies. The goal of this campaign is to optimize health outcomes for our members in-line with HEDIS/Stars recommendations. Calls will be conducted by Optum, a Blue Cross of Idaho contracted vendor. When will the campaign run? The call campaign will run from April 8 through September 30. How are members identified? We have identified Medicare Advantage (MA) members using data intelligence information. Those targeted are new and existing members who have HEDIS screening gaps, no primary care physician (PCP) claims in a rolling 12-month period, and/or have been identified as high risk for suspected risk adjusting conditions. PO Box 7408 Boise, Idaho Tel Health and wellness or prevention information Did you know that thousands of members have not completed their annual wellness exam for one or more years? This includes you. Preventive screenings remain the best way to detect early signs of severe illness. They help you live a longer, healthier life and keep costs for healthcare affordable. There s no good reason to skip your annual wellness visit, because there is no cost to you. Help Us Help You We ll call you in the next few weeks to help you make a convenient appointment. When you receive our call, we will: Confirm we are talking with the right member Explain why we are calling Help you make your annual wellness appointment Ensure members with chronic conditions receive needed care Or, take a proactive step and call us at (TTY 711), from 8:30 a.m. to 4:30 p.m., Monday through Friday An independent licensee of the Blue Cross and Blue Shield Association, with services provided by Blue Cross of Idaho Health Service, Inc. We need to talk Y0010_OP16196 What to expect and how this campaign may affect your office? Optum agents will have access to member-assigned PCP information as well as the Blue Cross of Idaho provider directory. As a MAcontracting provider, you may receive a call from an Optum agent with the member on the line requesting to schedule an appointment for wellness visit. If your office does not provide the services requested, please advise if there is a provider or facility that your office prefers our member to contact. Please know that if you or our member have any additional questions related to benefits and eligiblity during the call, the Optum agents will be able to provide you with appropriate contact information for the Blue Cross of Idaho Customer Service Department. What will happen during the campaign? Identified members have already started receiving campaign postcards by mail, as well as calls from Optum agents. During these calls, Optum agents will provide annual wellness exam and preventive health screening eduction. Additionally, Optum agents will help our members schedule appointments for these services with PCPs and specialits, as well as obtaining referrals when necessary. After an appointment is scheduled, Optum agents will also be available make reminder calls to the member for these appointments. Who do I contact if I have general questions/concerns related to the campaign? Blue Cross of Idaho Customer Service: Blue Cross of Idaho Provider Relations: Angie McCormick, CPC, CPC-P at ext 7032 or Kathy Brock, CPC-P at ext 8307 BLUE CROSS OF IDAHO Provider NEWSLETTER Spring 2016

2 Post-Service Inquiries If you have a post-service question, Blue Cross of Idaho offers several options to help you get your questions answered quickly and accurately. We started using our online inquiry system four years ago to help speed up the process for both online questions, as well as phone users who need time-sensitive pre-service and benefit information. The most common types of post-service inquires we help with are claims, remittance details, payments and appeals. Most post-service questions are easily answered by either reviewing claim information available online at providers.bcidaho.com, or by reviewing your remittance detail information. New Billing Requirements Blue Cross of Idaho implemented new billing requirements with the April 1, 2016, annual physician amendment. The contract language added to the contract states: Claims submitted using a CMS 1500 format, or its replacement, must be submitted electronically. Claims submitted using UB04 format, or its replacement, must be submitted using mutually acceptable and nationally approved formats. Please submit claims electronically to Blue Cross of Idaho using your billing solution software/clearinghouse, or through the Blue Cross of Idaho online Direct Claim Entry (DCE) application at providers.bcidaho.com. There are many benefits to submitting claims through an electronic version. Faster claims processing Reduction of administration costs Allows providers to meet KPI measure of electronic submission of claims You receive an immediate confirmation of acceptance of claim Through the DCE, you have the capability to attach medical records, invoice copies, coordination of benefit information or other documents you may need to submit with a claim. Hard copy claims submitted on the CMS 1500 form are now being returned with a request to resubmit using DCE. Those questions that can t be resolved either online or through the remittance detail, need to be submitted to Blue Cross of Idaho online through the secure provider portal at providers.bcidaho.com. Provider Administrative Policy (PAP) 206- Resubmission, Reprocessed, and Corrected Claims outlines the two ways to submit a post-service inquiry. If you do not have a secure login for the provider portal, you may utilize option 2. Please contact your provider relations department representative for questions or access to the provider portal (PAP 100). BLUE CROSS OF IDAHO PROVIDER NEWSLETTER SPRING 2016

3 New Faces Dereck R Leonard Dereck was born in Moscow, Idaho, but moved to Boise in He also spent time in Alaska on a mission. Dereck is the oldest of four children, with one brother and two sisters. He has his associates degree in Business Management/Marketing and plans to complete his bachelor s degree in Business Management at Boise State University by the end of this year (go Broncos! ). Dereck comes to Blue Cross of Idaho with six years of healthcare experience at both Saint Alphonsus Regional Medical Center and Interpath Labs. He moved from our Enrollment and Billing Services Department, where he spent more than a year helping groups. Retirements Pam Roach On May 5, Pam retired after 38 years with Blue Cross of Idaho. She came to the company in May 1976, fresh out of college and started in the FEP Claims Department. From there, Pam moved to the National Claims Department and then worked in a temporary capacity for two years when her two children were born. Pam came back permanently to the Special Claims Department, and then moved to Provider Relations in Over nearly 40 years, Blue Cross became her family. She gained many friends not only within Blue Cross of Idaho, but in the provider community as well. Pam says it has been an honor to work with so many talented people over the years. She watched the company grow from just more than 200 employees to the roughly 1,000 today and witnessed many changes in healthcare. Pam says she knows Blue Cross of Idaho will continue to be the best healthcare insurer in Idaho even after her departure. Chris Schutt In March, Chris retired after almost 21 years with Blue Cross of Idaho. Janie Tafoya On April 1, Janie retired after 11 years with Blue Cross of Idaho. Changes in Insulin Coverage Effective May 1, 2016, Blue Cross of Idaho is implementing a change for insulin prescription medication coverage. This change does not impact members of Qualified Health Plans (QPH), Federal Employee Program or Medicare Advantage. Members who are taking one of the brands of insulin no longer covered under the standard 3 and 4 Tier formularies have been notified of this change. To allow for time to transition members to a covered insulin product, coverage for the following brands of insulin is being extended through July 31, Members may contact you to discuss their treatment options and transition to the covered brands of insulin. Brands no longer considered in standard 3 and 4 Tier formularies: Apidra Humalog Humulin (except U-500) Novolin Relion Brands that are considered in the standard 3 and 4 Tier formularies: Lantus Levemir Novolin (except Relion) Novolog Toujeo Tresiba If you have questions regarding the benefits for covered insulin products please contact CVS/ Caremark at BLUE CROSS OF IDAHO PROVIDER NEWSLETTER SPRING 2016

4 Provider Relations Changes The changing landscape of the healthcare industry has created an opportunity for Blue Cross of Idaho to re-evaluate the functions that the Provider Relations Department has historically managed. That means you ll be noticing many upcoming changes to the structure and function of the department. Provider Relations is adding a focus on provider engagement and education regarding Medicare and QHP risk audit coding, documentation, HEDIS, STARS and Blue Cross of Idaho Truven scores. Employees taking on this role will be certified coders working in the field directly with our provider partners and risk vendors. Watch for more details as educational programs begin rolling out in the coming months. Beginning May 1, 2016, our internal Provider Relations staff will begin taking over functions previously handled by our external representatives. These functions include website training, website troubleshooting and other online portal applications. Going forward, you ll be able to get your website questions answered, as well as take advantage of training over the phone. Additionally, Blue Cross of Idaho is developing online educational materials, including video clips, to help with our web portal functionality, tools and applications. With this restructuring, Provider Relations is no longer handling direct calls or s related to routine claim questions. Instead, claim-specific questions are directed to the secure provider portal at providers.bcidaho.com using the claim status application. You can also submit questions through the Contact Us page. If we do receive any claim-specific calls or s, we will either reply with a request to submit through the secure provider portal or, if the question has already been submitted through the portal, forward your request to the appropriate department. We have created a designated unit to answer these questions, and provided its team members with additional tools and training to handle your claim questions. In addition to website questions and training, the Provider Relations representatives will continue assisting providers with questions pertaining to existing contracts or new requests, provider set-up, fee schedule clarifications, general coding or bundling, or general questions not related to a specific claim. We have updated Provider Administrative Policy 100 as well as the Contact Us page located at providers.bcidaho.com to reflect these changes. As with any transition, our goal is for as little disruption as possible. However, you may experience a slight delay in response during this implementation period. Please know that we are working diligently to make this a smooth transition. Caution in Using Out-of-Network Providers Blue Cross of Idaho reviews data to ensure we are advocating for cost-effective healthcare. Our recent data audit revealed a greater use of out-of-network laboratories and referrals to out-of-network providers. It s important for ordering and referring physicians to know the financial impact to patients when services are done by out-ofnetwork laboratories or other providers. Often, out-of-network laboratories and providers balance bill patients, sometimes for thousands of dollars. If a patient is unable to pay, the laboratory and/or provider may send the patient to collections. Some out-of-network laboratories engage in aggressive marketing practices, such as accepting any amount insurance pays, and promising not to balance bill patients. However, routine waiver of patient out-of-pocket expenses causes an increase in the utilization of healthcare services, and is illegal under Idaho Code Federal anti-fraud laws may also consider this a kickback. This can be confusing for our members, especially when an innetwork provider orders an out-of-network laboratory test or refers to an out-of-network provider. Blue Cross of Idaho issued Provider Administrative policies (PAPs) 287 and 637, requiring contracting physicians/clinics to refer services to an in-network laboratory or service provider, except as otherwise authorized by Blue Cross of Idaho. In the rare circumstance that a physician requires a specific laboratory test which a participating laboratory is not available, the physician should contact Blue Cross of Idaho in advance to confirm that the specific laboratory test is covered, or request assistance in locating a participating laboratory. Blue Cross of Idaho will continue to monitor the use of out-ofnetwork laboratories and providers and apply appropriate actions set forth in the PAP 287. BLUE CROSS OF IDAHO Provider NEWSLETTER Spring 2016

5 Know Who to Call Your network specialist may have changed. To make sure you re contacting the right person to help you, please see the current contact information for your specific facility or provider type listed below. This updated list includes some recent address changes. Provider Network Management Ancillary Provider Network Specialists (State Wide) Dialysis Audiology, Dietician, Home Health, Hospice, Independent NP, Optometrist, Mental Health Ambulance, Dental, DME, Home IV, Limited DME, Prosthetic/Orthotics, Skilled Nursing Facility. Chiropractic, Diagnostic Imaging, Independent Clinical Laboratory, PT/OT/ST, Sleep lab, Surgery Centers Government Programs All Medicare Advantage medical provider types (ef, hospitals, physicians, behavioral health, facilities, clinics, etc.) Statewide Medicare Medicaid Coordinated Plan (MMCP): HCBS, Expanded Mental Health, ICF/Long-Term Care, Certified Family Homes statewide Provider Network Management Specialists Providers: Treasure Valley Hospital Sarah Hart Provider Network Management Specialist, Sr. E: P: F: Noelle Bruce Provider Network Management Specialist E: P: F: Amy Farnworth Provider Network Management Specialist E: P: F: Christina Sears Provider Network Management Specialist E: P: F: Lauri Rowell Health System Performance Specialist E: P: F: Sheila Habblett Provider Network Management Specialist E: P: F: Stina Redford Provider Network Management Specialist, Sr. E: P: BLUE CROSS OF IDAHO Provider NEWSLETTER Spring 2016

6 Provider Network Management Specialists continued Providers: Benewah Community Hospital, Bonner General Hospital, Boundary Community Hospital, Clearwater Valley Hospital, Gritman Medical Center, Kootenai Medical Center, Northern Idaho Advanced Care Hospital, Northwest Specialty Hospital, Rehabilitation Hospital of the North West, Saint Marys Hospital and Clinics, Shoshone Medical Center, Southwest Idaho Advanced Care Hospital, Syringa General Hospital, Tri State Memorial Hospital Providers: Bear Lake Memorial Hospital, Caribou Memorial Hospital, Franklin County Medical Center, Lost Rivers Medical Center, Nell J Redfield Hospital, Portneuf Medical Center, Portneuf Medical Center Behavioral Health, Power County Hospital District, Saint Alphonsus Medical Center Nampa, Saint Alphonsus Medical Center, State Hospital South, State Hospital North, Steele Memorial Medical Center, Teton Valley Health Care, Saint Alphonsus Medical Center - Ontario Providers: Bingham Memorial Hospital, Boise VA Medical Center, Cascade Medical Center, Cassia Regional Medical Center, Eastern Idaho Regional Medical Center, Idaho Doctors Hospital, Intermountain Hospital, Madison Memorial Hospital, Minidoka Memorial Hospital, Mountain View Hospital, North Canyon Medical Center, Safe Haven Hospital of Treasure Valley, St Luke s Boise Medical Center, St Luke s Elmore, St Luke s Jerome, St Luke s Magic Valley Medical Center, St Luke s McCall, St Luke s Rehabilitation, St. Luke s Wood River, Valor Health, Weiser Memorial Hospital, West Valley Medical Center Provider Specialties: All Commercial Independent Physician Clinics statewide and IDID, Saint Joseph Regional Medical Center Sarah Hart Provider Network Management Specialist, Sr. E: sarah.hart@bcidaho.com P: F: Leslie Hazen Provider Network Management Specialist, Int. Provider Specialties: Saint Alphonsus, Saint Alphonsus Micron, Accountable Care Organization (ACO) Connected Care Organization (CCO) E: leslie.hazen@bcidaho.com P: F: Dan Polette Provider Network Management Specialist, Sr. Provider Specialties: CarePoint, St Luke s Micron, Primary Health, HCA Facilities E: dan.polette@bcidaho.com P: Becki Wallace Health System Performance Specialist E: becki.wallace@bcidaho.com P: F: BLUE CROSS OF IDAHO Provider NEWSLETTER Spring 2016

7 Follow these steps to complete an online coordination of benefits form: Log on to the secure provider portal at providers.bcidaho.com Select Forms & Resources at the top of the page Select Coordination of Benefits Online Coordination of Benefits If you receive a detail remittance with a claim denial reason of other health insurance information, you can enter the information of behalf of your patient online without waiting on the patient to complete it. This process will decrease claim processing time and speed up payments. Follow the instructions and submit the form to Blue Cross of Idaho, or you can contact your Provider Relations representative for assistance. For more information, please review Provider Administrative Policy 234 Coordination of Benefits/Reimbursement. Free Diabetic Meter Program As healthcare providers, you encourage your diabetic patients to take the right steps to manage their diabetes by eating healthy, exercising and checking their blood sugar using a blood glucose meter. To help in this effort, we re offering eligible Blue Cross of Idaho members a yearly OneTouch blood glucose meter at no charge. This additional value your patient receives as a Blue Cross of Idaho member. For your patient to qualify, he/she must: Be a Blue Cross of Idaho member Please note: Members must have a commercial or qualified health plan with pharmacy benefits through CVS/Caremark. Have Type 1 or Type 2 diabetes mellitus Have a valid prescription for OneTouch blood glucose test strips Also, your patient may qualify for a lower copayment because OneTouch is our preferred vendor. Your patient may choose from one of the following meters: OneTouch Ultra 2 OneTouch Ultra Mini OneTouch Verio IQ Blue Cross of Idaho is sharing this offer with eligible members. Members can contact the CVS/Caremark diabetic meter program team at to verify their eligibility for the program. 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 your patients health than you realize, and screening could impact your patients quality of life. Remember to talk to your patients about the following preventive screenings: Breast cancer screening Mammogram within the past two years Colorectal cancer screenings Annual fecal occult blood test (FOBT) Colonoscopy every 10 years Annual flu vaccine Body mass index (BMI) Preventive screenings and close monitoring of chronic diseases can be the first step to a healthier life for your patients. Make sure they are up to date on all preventive screenings by suggesting a wellness exam today. BLUE CROSS OF IDAHO PROVIDER NEWSLETTER SPRING 2016

8 Any Questions? Medical Management Managed Health Care/Review, Preadmission/Admission Certification, or Individual Benefits Management and Case Management Voice mail available after office hours and on holidays and weekends Blue Cross of Idaho Help Desk Electronic Billing Errors, Error and Acceptance Reports 8 a.m. 5 p.m. MT (Monday Friday), 888-BCI-EDIA, or Provider Contact Center for Commercial and Medicare Advantage Benefi ts, Coverage and Authorization 8 a.m. 5 p.m. MT (Monday, Tuesday, Thursday, Friday) 8:30 a.m. 5 p.m. MT (Wednesday) or Post-service claim questions log onto our secure website at providers.bcidaho.com and select Contact Us. Provider Relations Representative Questions regarding coding, contracting or need website training, you may contact one of the following provider relations representatives or Ext. 8326: Leah Hulse CPC Counties: Benewah, Bonner, Boundary, Clearwater, Idaho, Kootenai, Latah, Lewis, Nez Perce and Shoshone Ext. 8306: Jamie Hunihan Counties: Adams, Boise, Canyon, Gem, Owyhee, Payette, Valley and Washington Ext. 8304: Heidi Lowman Cities: Boise and Meridian Ext. 8310: Jenn Lucy, CPC Counties: Bannock, Bear Lake, Bingham, Blaine, Bonneville, Butte, Camas, Caribou, Cassia, Clark, Custer, Franklin, Fremont, Gooding, Jefferson, Jerome, Lemhi, Lincoln, Madison, Minidoka, Oneida, Power and Teton Ext. 9005: Kylee Williams Cities: Eagle, Garden City, Kuna and Star. Counties: Elmore and Twin Falls BLUE CROSS OF IDAHO PROVIDER NEWSLETTER SPRING 2016