Administering DTaP during the Shortage

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1 PROVIDER SERVICES Policies/ Procedures/ Claims HMO 215/ / * PPO 800/ PHARMACY SERVICES Prescription Drug Authorization 888/ Toll-Free Fax 888/ Blood Glucose Meter Hot Line (option 2) 888/ HEALTH RESOURCE CENTER 215/ / * PRECERTIFICATION/ PATIENT CARE MANAGEMENT HMO Commercial 215/ / * Medicare 215/ / * PPO 215/ / * Medicaid February 2002 Important Billing Information Regarding Performing Providers When billing for HMO, POS, and PPO services, please remember to include the provider identification number of the physician or other professional provider performing the procedure or service. The performing provider identification number should be reported in section 24.K of the HCFA 1500 Claim form or section 24.H of the HCFA 1500A claim form. When submitting electronic claims, the performing provider identification number should be entered in the rendering provider identification field. Diphtheria, Tetanus, and Acellular Pertussis Vaccine Shortage On January 4, 2002, the Centers for Disease Control and Prevention (CDC) published a Notice to Readers: Update, Supply of Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine in the Morbidity and Mortality Weekly Report (MMWR). Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) are in short supply. The shortage, which began in 2000 when the number of U.S. manufacturers of the vaccine decreased from four to two suppliers, is expected to continue into mid Administering DTaP during the Shortage DTaP is recommended as a five-dose series: three doses administered to infants at ages two, four, and six months of age followed by one dose between months of age and one dose at four to six years of age. During the DTaP shortage, the Advisory Committee on Immunization Practices (ACIP) recommends that providers who do not have enough DTaP to vaccinate all children with five doses give priority to vaccinating infants with the first three doses. The ACIP recommends taking the following steps to help maintain an adequate supply of DTaP to vaccinate infants:

2 800/ THE SUPPLY LINE 800/ VISIT OUR WEB SITE AT Defer vaccination of children months of age with the fourth DTaP dose. Defer the fifth DTaP dose (given to children four to six years of age). In areas with severe DTaP shortages, local public health officials might elect to recommend community wide deferral of the fourth DTaP dose, and if necessary, the fifth DTaP dose. * Outside 215 area code The Independence Blue Cross (IBC) Partners in Health Monthly Update is a publication of the Provider Communications department for the exchange of information and ideas among the IBC Provider community. Suggestions and contributions are welcome. To submit or suggest an article, contact: Arthur C. Leaphart, III Editor Provider Communications Independence Blue Cross 1901 Market Street, 27th Floor Philadelphia, PA arthur.leaphart@ibx.com IBC offers products directly, through its subsidiaries Keystone Health Plan East and QCC Ins. Co., and with Pennsylvania Blue Shield-independent licensees of the Blue Cross and Blue Shield Association. The third-party Web sites mentioned in this publication are maintained by organizations over which IBC exercises no control, and accordingly, When the DTaP shortage ends, providers should recall and administer DTaP to all children who missed a dose. Vaccination of children four to six years of age is needed to provide immunity to pertussis, diphtheria, and tetanus during the elementary school years. Visit for more information on the DTaP shortage. New Addition to Our Laboratory Network We are pleased to announce the immediate addition of Health Network Laboratories to our network of participating laboratory providers. Whether your office selects Health Network Laboratories as its contracted laboratory or directs PPO members to them when appropriate, the addition of a new laboratory provider to our network increases laboratory availability and convenience for our physicians and members. Your office can arrange an account with Health Network Laboratories by calling 877/ , extension In addition to Health Network Laboratories, Quest Diagnostics, Inc. and Laboratory Corporation of America continue as network laboratories. If you use any of these laboratories, we encourage your office to set up an account with them. Specialists that draw or collect specimens should establish accounts with all three laboratories since they are required to send HMO members laboratory specimens to the member s PCP s contracted laboratory. Maintaining an account with a participating laboratory improves record keeping, promotes communication between the laboratory and physician, and facilitates supply receipt. The Client Services Department at Quest Diagnostics can be reached at 800/ ; Laboratory Corporation of America can be reached at 866/ If you have any questions concerning network laboratories please contact Provider Services or your Network Coordinator. New HMO Dermatopathology Providers

3 IBC disclaims any responsibility for the content, the accuracy of the information, and/or quality of products or services provided by or advertised in these thirdparty sites. URLs are presented for informational purposes only. Certain services/treatments referred to in third-party sites may not be covered by all benefit plans. Members should refer to their benefit contract for complete details of the terms, limitations, and exclusions of their coverage. Effective immediately, dermatopathology specimens for HMO patients may be sent to Dianon Laboratories and to The Institute of Dermatopathology. These new dermatopathology laboratory providers will increase laboratory availability and convenience for our physicians and members. Specialists may submit dermatopathology specimens to these laboratories without a referral from the patient s PCP. Physicians may continue to use the member s PCP s contracted laboratory for dermatopathology if the laboratory performs the required study. To facilitate the proper testing of specimens, clearly indicate on the laboratory requisition form that you are requesting dermatopathology or hematopathology studies. Physicians can continue to use Dianon Laboratories and The Institute for Dermatopathology for PPO patients. Case Management Programs on the Web IBC has developed several case management programs, including our Connections SM Case Management programs to assist physicians in the management of patients with chronic illnesses. Our award-winning Baby BluePrints Maternity Management Program assists physicians in the management of expectant mothers. Our Individual Case Management and Keystone 65 Patient Care Management programs assist physicians in the coordination of care and education of specific members. These programs are offered at no additional cost to our members enrolled in managed care plans (HMO, PPO, and POS). To learn more about what our case management programs can do for your patients, visit us on the Web at Connections SM Case Management For patients who suffer from chronic illnesses, our ConnectionsSM Case Management programs offer education and support from specifically trained registered nurse case managers. They work closely with you and your patients to help prevent complications and to help improve your patients overall health and quality of life. Connections SM Case Management offers disease specific management programs for: Asthma. Diabetes. Chronic Obstructive Pulmonary Disease (COPD).

4 Cardiac. Congestive Heart Failure. To learn more about our Connections SM programs, visit us on the Web or call 800/ Baby BluePrints In addition to our disease specific programs we also offer perinatal case management through our Baby BluePrints Program. Registered nurse case managers experienced in high-risk obstetrical care work with the physician and the member to educate and support the member through her pregnancy. Mothers-to-be are offered: Educational materials for each stage of pregnancy. Personalized case management for high-risk pregnancies - 24 hours a day, 7 days a week. Our Mother s Option Program, which offers the choice of either a longer hospital stay or home care visits after their delivery. A breast pump reimbursement of up to $50 and lactation services (if needed). A childbirth class reimbursement of up to $50. A brand new Baby BluePrints Web site is under construction. Call 800/598- BABY for more information. Individual Case Management The Individual Case Management (ICM) department consists of nurse case managers who assist in the coordination of the health care and educational needs of specific members. ICM specializes in areas that include: Transplant Pediatrics Adult/Complex Case Management Our nurse case managers will work with members, providers, and facilities as required to ensure that the needs of patients and their families are met. If you have a patient who may benefit from individual case management, please call 800/ for more information. Keystone 65 Patient Care Management

5 We also offer individual case management to our Keystone 65 population. Through a proactive Health Risk Assessment, which is sent to members within the first 90 days of enrollment with our plan, we are able to assess health risks and communicate with members, physicians, and caregivers to facilitate delivery of quality care. We offer nutrition evaluations, medication evaluations, and depression screenings. This year, we anticipate approximately 28,000 new Keystone 65 members to join the plan. To refer a member to Keystone 65 Patient Care Management, please call 215/ (800/ outside the 215 area code). Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Co., and with Pennsylvania Blue Shield - independent licensees of the Blue Cross and Blue Shield Association.