Beginning in March 2012, Healthcare

February 2012 NETWORK news News from Premera Blue Cross Blue Shield of Alaska HEDIS is a set of nationally recognized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). COMPANY Updates HEDIS Medical Record Review Starts in March Beginning in March 2012, Healthcare Effectiveness Data and Information Set (HEDIS) reviewers will examine a sample of medical records to measure quality and monitor Premera s performance. HEDIS is a set of nationally recognized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS medical record review occurs each year and is focused on health plan quality and performance it is not a physician review. Contents Company Updates page 1-2 Online Services Updates page 2-3 Claims & Payment Policy Updates page 4-5 Reminders & Tips page 6 Administrative Resources page 7 Pharmacy Updates page 8 Medical Policy Updates page 9-11 What is the providers role? Most of the information required by HEDIS can be obtained from claims; however, additional information must be collected by medical record review. Premera has contracted with Q Mark Inc. to review medical records. Q Mark representatives may request that providers fax portions of a medical record to them for review. Q Mark may also contact providers to schedule onsite visits. Which HEDIS measures require chart reviews? Childhood immunizations Cholesterol management for patients with cardiovascular conditions Controlling high blood pressure Comprehensive diabetes care (e.g., eye exam, HbA1c, LDL-C, nephropathy, blood pressure) Prenatal and postpartum care What about Patient Privacy and HIPAA requirements? Q Mark serves Premera in a role that is defined and covered by the Health Insurance Portability and Accountability Act (HIPAA). As defined by HIPAA: The HIPAA Privacy Rule permits a provider to disclose protected health information to a health plan for the quality-related health care operations of the health plan. Language in the Premera provider contract also allows the review of medical information of current or former Premera members for quality improvement activities without member authorization. Who should I contact if I have questions? If you have questions about HEDIS, visit ncqa.org or call Physician and Provider Relations at 800-722-4714, option 4. An Independent Licensee of the Blue Cross Blue Shield Association February 2012 Alaska Network News 1

COMPANY Updates Spring Office Staff Workshops: April 16 19, 2012 Provider office staff members are invited to attend the Premera Blue Cross Blue Shield of Alaska spring workshops. The workshops are scheduled as follows: Fairbanks: April 16 Fairbanks Princess Lodge 12-2:30 p.m. Anchorage: April 17 Captain Cook Hotel 8-11 a.m. & 12-2:30 p.m. Wasilla: April 18 Evangelos 12-2:30 p.m. Juneau: April 19 Juneau Arts & Culture Center 12-2:30 p.m. Workshops are for Premera contracted providers only. Please look for your individual workshop invitation in the mail in mid-march. We look forward to seeing you there! Holiday Closure Dates for 2012 Premera will be closed on the following dates: Monday, May 28 Wednesday, July 4; Thursday, July 5 Monday, September 3 Thursday, November 22; Friday, November 23 Monday, December 24; Tuesday, December 25 Premera.com/provider is the most efficient and accurate way to access eligibility and claims status information. There you have easy access to our Prospective Review, Claims Editor, and Real Time Estimates/Claims tools, payment policies, medical policies, forms, provider communications, and the Premera Provider Reference Manual. If you have questions or need education to use our provider portal tools you may access tutorials located on onehealthport. com or call Physician and Provider Relations at 800-722-4714, option 4. ONLINE SERVICES Update Sign-up for OneHealthPort s Electronic Newsletter OneHealthPort emails periodic announcements and newsletters with news and information about healthcare technology, security developments, and community events. Providers and office staff can subscribe at: onehealthport.com/news/newsletter_sign_up 2 February 2012 Alaska Network News

ONLINE SERVICES Updates Mobile Proof of Coverage Now Available to Members Premera s new mobile app provides members with mobile proof of coverage that can be used when they don t have their Premera ID card with them at the time of service. The app also gives members the ability to email proof of coverage to those providers who are set up to receive secure email. Mobile proof of coverage is rendered directly from the Premera eligibility system, so providers can be assured it is the most current, accurate information. There are two ways members can provide coverage information through mobile proof of coverage: Members can display the mobile proof of coverage page on their phone. This page contains all the relevant pieces of information providers need to verify benefits and submit claims including the member s alpha prefi x, ID number, and claims address. Members can email a proof of coverage document from their phone. Providers will need to supply the member with a secure email address to receive the document. Many providers are establishing electronic communications with patients; this technology eliminates the need to call customer service to confirm eligibility and offers convenience for members and providers. More Enhancements to the Online Provider Finder Premera members now have easier access to physician quality and patient reviews from HealthGrades, thanks to a Dec. 16, 2011, update to the Premera online directory. This enhancement demonstrates our commitment to providing members with tools to help them actively manage their healthcare. This update is part of our continuing efforts to enhance our Find a Doctor search tool on the member portal. In addition to listing providers, the online provider finder helps members compare provider information. We will continue to improve the provider finder with additional tools and information, including expanded cost data and cost averages in 2012. Check the provider portal for updates. For information about the improvements made earlier this year, check out the August 2011 Network News located under Communications at premera.com/provider. Online Prospective Review Tool Saves Time and Phone Calls Do you regularly call Premera Customer Service to determine if a service is subject to medical necessity review? You can save a phone call by using the online Prospective Review tool. From the provider portal landing page, select Prospective Review under Utilization Review (see Figure 1). You will need the member s ID number, the specific code, and the date of service. Important: Advanced imaging services for Computerized Tomography (CT), MRI/MRA and Nuclear Cardiology are reviewed for medical necessity. Submit a request for review when ordering an advanced imaging service online at americanimaging.net or by phone, Figure 1: Prospective Review tool on the provider portal 866-666-0776. February 2012 Alaska Network News 3

CLAIMS & PAYMENT POLICY Updates Use Modifier TH for Three or Fewer Prenatal Services There are several reasons a provider may only see a patient for three or fewer prenatal visits. For instance, the patient may transition to a new provider, experience a termination of pregnancy, or change their healthcare coverage. Effective immediately, if you encounter a situation where you to need to report three or fewer prenatal services, please code the appropriate evaluation and management code appended with the modifier TH. This will allow us to recognize the situation and process your claim appropriately. For more information, see the Maternity Services payment policy located with all other payment policies under Reference Info in the online Library. If you have questions, call Physician and Provider Relations at 800-722-4714, option 4. Centers for Medicare and Medicaid Services offer ICD-10 Implementation Handbooks CMS has developed Implementation Handbooks as additional resources to assist providers with the transition from ICD-9 to ICD-10 codes (compliance mandated by Oct. 1, 2013). Each guide provides detailed information for planning and executing the ICD-10 transition process. Use the guides as a reference whether you re in the midst of the transition or just beginning the process. The appendix of each handbook references relevant templates which are available for download in both Excel and PDF files. The templates are customizable and have been created to help entities clarify staff roles, set internal deadlines/responsibilities and assess vendor readiness. View the tailored step-by-step plans and relevant templates for each of the following practice sizes impacted by the transition: Large Provider Practices Small Hospitals Small/Medium Provider Practices Link to CMS Implementation Handbooks and all CMS ICD-10 resources: cms.gov/icd10/02b_latest_news The migration from the current ICD-9 standard to the ICD-10 standard will represent one of the most significant changes in healthcare information in many years. The best way to know what solutions you need is to fully understand ICD-10 and its impact in your business. If you haven t already started your ICD-10 implementation plan, please consider starting today! 4 February 2012 Alaska Network News

CLAIMS & PAYMENT POLICY Updates HIPAA 5010 Compliance Extended On Nov. 17, 2011, the Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (CMS OESS) announced that it will not enforce compliance with the HIPAA version 5010 until March 31, 2012. CMS OESS is the division of U.S. Department of Health and Human Services (HHS) that enforces compliance with HIPAA transactions and code set standards. The HHS had previously directed that all HIPAA-covered entities comply by Jan. 1, 2012. You can view the announcement on the CMS website: CMS Statement 5010 Enforcement Although compliance enforcement has been extended, OESS encourages all covered entities to continue working with their Trading Partners* to determine their readiness and comply with the new HIPAA version 5010 standards by Jan. 1, 2012. What is the status of Premera s implementation? Premera EDI is actively testing version 5010 with all willing Trading Partners. Once testing is completed, we will notify providers about when to begin sending electronic transactions using version 5010. Premera and other payers, providers, and state agencies have developed Administrative Simplification Best Practice Recommendations (BPRs) for HIPAA 5010 electronic transactions, rather than separate companion guides. HIPAA 5010 BPRs can be found at: onehealthport.com/worksmart/ worksmart/bproverview Don t wait! If you have not yet started 5010 testing with us, please contact our EDI Team to get started today. If you are a provider who bills claims from your office directly to Premera, but are considering a change to a clearinghouse for the 5010 transition, please email the EDI Team at edi@premera.com, or call 800-435-2715. *Trading Partners are healthcare clearinghouses, billing services, providers, payers, financial institutions, applicable employer groups, etc. What does this mean to you? All Trading Partners who send and/or receive electronic transactions, (claims, remittance advice, eligibility and benefit information, claims status, etc.) should continue their efforts to become HIPAA 5010 compliant between now and March 31, 2012. Effective April 1, 2012, all Trading Partners must send and receive electronic standard transactions in version 5010 (with Errata changes). Address Guidelines for HIPAA 5010 When submitting version 5010-compliant electronic transactions, follow these guidelines: Billing Provider Address (Loop 2010AA): Must be a complete (physical) street address. It cannot be a P.O. Box or lock-box. Pay-To Address (Loop ID-2010AB): Complete if your remittance (payment) address is different from the Billing Provider Address, or is a P.O. Box or lock-box. We encourage providers to contact their clearinghouse or system vendor to ensure these guidelines are followed. Incorrect address field content will result in claim rejection errors. If you have questions about these guidelines, call EDI at 800-435-2715. February 2012 Alaska Network News 5

REMINDERS & Tips UB-04 Billing Guidelines for Facility Claims The UB-04 is the standard claim form used to bill facility services to Premera and its affiliates. Submitting the claim form with all required fields will assist us in paying your claim in a timely manner. Claim forms that are missing one or more of the required fields may be rejected or denied. When completing the UB-04, follow the guidelines provided in the National Uniform Billing Manual for all facility services rendered to a member. It is also necessary to follow the established definitions and guidelines for each type of diagnosis or procedure code used (i.e., CPT, ICD-9, and HCPCS). Careful attention to the following items on the UB-04 will also assist us in processing your claim accurately and promptly: Service Date (form locater 45): Outpatient Claims: This is a mandatory field and must be populated. Inpatient Claims: Room and board lines must be itemized - one line for each date of service. Type of Bill (form locater 4): The third digit of the type of bill indicates whether the bill is a final, interim, corrected, or supplemental claim. This affects the benefit payment so be sure to use the appropriate code to avoid incorrect payment and subsequent reprocessing of a claim....... REMINDERS..&TIPS Patient Status (form locater 22): The patient status code is a required item and must be available to identify transfer situations. Occurrence Codes (form locaters 32 36): Occurrence codes and dates should be completed for all accident, maternity, and illness claims. Room Rate (form locater 39): Indicate the semi-private room rate. Facilities that do not have a semi-private room rate for the service should include the private room rate dollar value in this fi eld. When completing the form be sure to include information regarding other insurance coverage, the facility tax identification number, itemized dates of service, procedure codes, and revenue codes to assist in proper and timely payment of all claims. For additional information you can reference: The National Uniform Billing Manual at nubc.org The Medicare Hospital Manual at cms.hhs.gov in the Regulations and Guidance - Manuals section (reference paper based manuals). Diagnosis and procedure code guidelines at cms.hhs.gov/home/medicare.asp in the Coding section. Tips to Ensure Proper Claims Imaging and Prevent Delays Electronic Submission Still Ensures Fastest Claims Turnaround If your office submits paper claims, you should consider the benefits of electronic claims submission. For instance, billing Premera electronically can significantly improve the turnaround time of your payments, compared with billing on paper. Electronic submission: 7 15 days Typed standard claim form: 15 21 days To learn more about the benefits to provider, or to get started, contact EDI at 800-435-2715 or email EDI@premera.com. To speed processing of paper claims, Premera uses document imaging and optical character recognition (OCR) equipment to read your claims. Tips to ensure that OCR reads your paper claims accurately: Use only red CMS-1500 forms (no photocopied forms). Type forms in black ink (handwritten forms cannot be read by OCR equipment). Don t fold, staple or tape your claim. Be sure information lines up correctly within the respective fi elds (data that overlaps another fi eld/box cannot be read accurately). Don t write or stamp extra information on the form. Other substances that hinder OCR imaging: White correction fluid Highlighters (claim information cannot be seen when imaged) Grease pencils Light ink, poor quality ink Non-standard fonts (standard fonts recommended: Times New Roman/Arial) 6 February 2012 Alaska Network News

ADMINISTRATIVE Resources Disease Management Program Changes Providers can now refer eligible Premera members to receive personal health support by calling 800-722-4714, option 6. The team is available weekdays, 8 a.m. to 8 p.m., PST to take referrals by phone and answer questions about the program. Our personal health support approach replaces our previously outsourced disease management program. This transition is part of our efforts to support better management of the five chronic conditions responsible for approximately 75 percent of healthcare costs among Americans: Asthma Chronic Obstructive Pulmonary Disease (COPD) Coronary Artery Disease Diabetes Heart Failure Personal health support is available to eligible health plan members with one of the conditions listed above. Participant identification is based on claims data or referrals from healthcare providers. Once identified, members will receive a phone call or a letter from Premera with more detailed information. Participation is voluntary. Members who choose to participate will receive condition-specific newsletters with information to help them identify specific health goals and tips for making healthy lifestyle changes. Members may also be identified for regular pre-scheduled phone calls from a personal health support coach. Centers for Disease Control and Prevention How is the Network News working for you? Do you find the information in this publication useful, informative, and timely? Does the Network News offer your practice and office staff the information they need? Do you receive the newsletter in the mail or do you use the online version at Premera.com/provider? What suggestions and input do you have that would help the Network News better serve your needs? Please send your input regarding the Network News in an email to provider.relationswest@premera.com. Don t Forget Send Provider Updates and Changes 30 days in Advance Reminder: Send dprovider Updates and Changes 30 days in Advance Please notify Premera of any updates or changes to your practice information 30 days prior to the change. This allows us to update our payment systems and provider directory so your patients have accurate contact information and your payments are sent to the correct address. This includes changes to your provider information, such as: Company tax identification number (TIN) changes Company name or legal entity name changes Practice address changes Phone number updates Billing addresses changes Adding new practitioners to the clinic (Premera typically requires a credentialing application) Practitioner terminations Providers can notify Premera of any new information or changes by email, using the Contracted Provider Information Change/Update Form. The form is located at premera.com/provider in the online Library, under Forms, Miscellaneous. You can also send updates by fax: 425-918-4937, email: provider.relationswest@premera.com; or mail: Premera Blue Cross, Attn: Provider Relations, P.O. Box 327, MS 453 Seattle, WA 98111-0327. Questions should be directed to Physician and Provider Relations at 800-722-4714, option 4. We would like to hear from you! February 2012 Alaska Network News 7

PHARMACY Updates Biotech and Point of Sale (POS) Edit Expansion Premera has added new review criteria based on clinical best practice and approval by an independent Pharmacy and Therapeutics Committee. The program is designed to promote appropriate drug selection, length of therapy and utilization of specific drugs while improving the overall quality of care. Newly added Biotech and POS Edit and POS Program drugs may be added or deleted from this list without prior notification. If you have questions, please call the Pharmacy Services Center at 888-261-1756 or fax us at 888-260-9836, Monday through Friday, 8 a.m. 5 p.m. Pacific Time. New Edits in the Prior Authorization/Point of Sale Program Effective March 1, 2012 Ophthalmic Prostaglandins Lumigan (bimatoprost ophthalmic solution) Travatan Z (travoprost ophthalmic solution) Xalatan (latanoprost ophthalmic solution) https://www.premera.com/stellent/groups/public/documents/ medicalpolicy/cmi_037976.pdf Coverage Criteria Lumigan, Travatan Z or Xalatan, may be considered medically necessary when there has been a trial and failure of latanoprost. Please note: The criteria will apply to new therapy requests only. Current members will automatically be grandfathered if on therapy prior to March 1, 2012. There will be no one-time override allowed when criteria is not met for this medication. New Edits in the Biotech Edit Program Effective March 1, 2012 Gilenya (fingolimod) https://www.premera.com/stellent/groups/public/documents/ medicalpolicy/cmi_119667.htm Gilenya is a specialty pharmacy drug covered under the pharmacy benefit. Coverage Criteria Approval for prior authorization requires that all of the following criteria be met: Patient must have a diagnosis of relapsing/remitting Multiple Sclerosis Patient must have an Expanded Disability Status Score (EDSS) of less than 6. Gilenya is not to be used concurrently with other Multiple Sclerosis disease modifying drugs. Quantity limited to achieve a dosage of 0.5mg per day. The quantity may not exceed a dosage of 0.5mg per day. Quantities in excess of 0.5mg per day are considered not medically necessary. Zelboraf (vemurafenib) Zelboraf is a specialty pharmacy medication covered under the pharmacy benefit. Coverage Criteria Zelboraf may be approved for the treatment of metastatic or unresectable melanoma. The initial approval period will be three months. Continued approval beyond the first three months of therapy will require documentation that there has been no disease progression while on the current therapy. Please note: The criteria will apply to new therapy requests only. Current members will automatically be grandfathered if undergoing therapy prior to March 1, 2012. 8 February 2012 Alaska Network News

MEDICAL POLICY Updates Physicians, Providers and Office Staff Premera medical policies are guidelines used to evaluate the medical necessity of a particular service or treatment. We adopt policies after careful review of published, peer-reviewed scientific literature, national guidelines and local standards of practice. Since medical technology is constantly changing, we reserve the right to review and update our policies as appropriate. When there are differences between the member s contract and medical policy, the member s contract prevails. The existence of a medical policy regarding a specific service or treatment does not guarantee that the member s contract covers that service. Medical policies are available on premera.com/provider; click on Medical Policies under Reference Info. If you would like a copy of a particular medical policy and are unable to obtain it online, email your request to medicalpolicy@premera.com. Note: We are no longer use the BC and PR alpha-digit prefixes on the medical policies, and they no longer appear on the websites. The following policy changes are effective for dates of service of Oct. 11, 2011 and later: 2.04.44 Genetic Testing for Cutaneous Malignant Melanoma. Genetic testing for mutations associated with familial cutaneous malignant melanoma or associated with susceptibility to cutaneous malignant melanoma, previously considered medically necessary, is now considered investigational. 2.04.74 DNA-Based Testing for Adolescent Idiopathic Scoliosis. New policy. DNA-based prognostic testing for adolescent idiopathic scoliosis is considered investigational. 7.03.11 Total Artificial Hearts and Implantable Ventricular Assist Devices. Percutaneous VAD s, previously not addressed, added to policy statement as investigational. 8.01.33 High-Dose Rate Temporary Prostate Brachytherapy. High-dose rate prostate brachytherapy for salvage therapy in prostate cancer, previously not addressed, is considered investigational. The following policy changes are effective for dates of service of Nov. 8, 2011 and later: 1.01.05 Ultrasound Accelerated Fracture Healing Device. Low intensity ultrasound treatment previously considered investigational for delayed union of bones, excluding the skull and vertebra, may now be considered medically necessary. Definitions for fresh fractures and delayed union added. 2.01.39 Quantitative Sensory Testing. Policy statement expanded to include vibration threshold testing and thermal threshold testing as investigational. 2.03.07 Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for the Treatment of Pseudomyxoma Peritonei, Peritoneal Carcinomatosis of Gastrointestinal Origin and Peritoneal Mesothelioma. Policy statement added: Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of peritoneal mesothelioma, previously not addressed, may be considered medically necessary. Use of the term hyperthermic changed to perioperative in the title and policy statements to include early postoperative intraperitoneal chemotherapy. 2.04.75 NOTCH3 Genotyping for Diagnosis of CADASIL. New policy. NOTCH3 testing for the diagnosis of CADASIL is considered investigational. 5.01.527 Oral Agents for the Treatment of Multiple Sclereosis. Fingolimod (Gilenva), previously not addressed, may now be considered medically necessary for treatment of relapsing-remitting MS when criteria are met. 8.01.57 Baroreflex Stimulation Devices. New policy. Use of baroreflex stimulation implanted device is considered investigational. 8.01.58 Auricular Electrostimulation. New policy. Electrical stimulation of auricular acupuncture points is considered investigational. 9.03.25 Gas Permeable Scleral Contact Lens. New policy. Rigid gas permeable scleral contact lens may be considered medically necessary when criteria are met. February 2012 Alaska Network News 9

MEDICAL POLICY Updates The following policy changes are effective for dates of service of Dec. 13, 2011 and later: 2.04.56 Immune Cell Function Assay. New investigational indication added for HSCT and all other indications. 2.04.76 Quantatitive Assay for Measurement of HER2 Total Protein Expression and HER2 Dimers New policy. The assessment of HER2 status by quantitative total HER2 protein expression and HER2 homodimer measurement is considered investigational. 5.01.529 Opioid and Non-Opioid Analgesics. Policy updated with additional approval parameters and dosing limitation for OxyContin. 6.01.30 Lung Cancer Screening Using CT Scanning or Chest Radiographs. Low-dose CT scans for lung cancer screening changed from investigational to medically necessary when done annually for 3 consecutive years for selected individuals and investigational in all other situations; criteria based on eligibility in National Lung Screening Trial. The following policy changes are effective for dates of service of Jan. 10, 2012 and later: 2.04.77 BRAF Gene Mutation Testing to Select Melanoma Patients for BRAF Inhibitor Therapy. New policy. Testing for the BRAFV600 mutation in tumor tissue of patients with stage IIIC or IV melanoma may be considered medically necessary to select patients for treatment with vemurafenib. 2.01.503 Diagnosis and Management of Obstructive Sleep Apnea and Upper Airway Resistance Syndrome. Code A9279 Monitoring feature/ device added to policy as non-covered DME. 5.01.602 Pharmacologic Treatment of Inflammatory Bowel Diseases. Adalimumab, previously considered investigational to treat ulcerative colitis, may now be considered medically necessary when criteria are met. 7.01.131 Transcatheter Pulmonary Valve Implantation. New policy. Transcatheter pulmonary valve implantation is considered medically necessary for patients with prior repair of congenital heart disease and right ventricular outflow tract (RVOT) dysfunction, who are not good candidates for open repair. 7.01.537 Artificial Disc: Cervical Spine. Policy statement clarified to allow for acute onset of myelopathy without need for 6 weeks conservative treatment. 7.02.01 Monitored Anesthesia Care (MAC). Policy statement changed. Information about the BMI [body mass index] for morbid obesity changed from > 50 to >40) 9.03.21 Aqueous Shunts for Glaucoma. Policy statement changed. Insertion of aqueous shunts for all other conditions, other than those specified in the policy, previously considered not medically necessary, are now considered investigational. 9.03.26 Viscocanalostomy and Canaloplasty. New policy. Canaloplasty continues to be considered medically necessary when criteria are met. New policy statement added: Viscocanalostomy, previously not addressed, is considered investigational. 10 February 2012 Alaska Network News

MEDICAL POLICY Updates The following policy changes are effective for dates of service of May 20, 2012 and later: 8.01.49 Intensity-Modulated Radiation Therapy (IMRT): Abdomen and Pelvis. New policy. Intensity modulated radiation therapy may be considered medically necessary as an approach to delivering radiation therapy for patients with cancer of the anus/anal canal. Except as noted above, intensity-modulated radiation therapy (IMRT) is considered investigational for the treatment of tumors (malignancies) of the abdomen and pelvis including: stomach (gastric), hepatobiliary tract, and pancreas; and rectal locations; and gynecologic tumors including cervical, endometrial, and vulvar cancers. 8.01.525 Intensity-Modulated Radiation Therapy (IMRT): Malignant and Non-malignant Neoplasms of the Head and Neck or Thyroid. New policy. Intensity-modulated radiation therapy may be considered medically necessary for the treatment of head and neck cancers. Intensity-modulated radiation therapy may be considered medically necessary for the treatment of anaplastic thyroid cancer. Intensity-modulated radiation therapy is considered investigational for the treatment of all other thyroid cancers. 8.01.526 Intensity-Modulated Radiation Therapy (IMRT) of the Prostate. New policy. Intensity-modulated radiation therapy (IMRT) may be considered medically necessary in the treatment of localized prostate cancer for dose escalation greater than 75 Gy. Intensity-modulated radiation therapy is considered investigational when used in combination with radioactive implant treatment (brachytherapy). 8.01.527 Intensity Modulated Radiation Therapy (IMRT) of the Breast and Lung. New policy. Intensitymodulated radiation therapy (IMRT) is considered not medically necessary as a technique to deliver right whole breast irradiation in patients receiving treatment for breast cancer after breastconserving surgery. Intensity-modulated radiation therapy (IMRT) may be considered medically necessary as a technique to deliver left whole breast irradiation in patients with lesions in close proximity to the heart or other cardiovascular structures who are receiving treatment for breast cancer after breast-conserving surgery, Intensity modulated radiation therapy (IMRT) of the breast is considered investigational as a technique of partial breast irradiation after breastconserving surgery. Intensity-modulated radiation therapy (IMRT) is considered not medically necessary as a technique to deliver radiation therapy in patients receiving treatment for lung cancer. 5.01.535 Erythropoiesis-Stimulating Agents (ESAs). New policy. Erythropoiesis-Stimulating Agents (ESAs) may be considered medically necessary for certain conditions when specific criteria are met. Investigational uses are also described. 7.01.116 Facet Joint Denervation. Laser denervation, cryodenervation, and therapeutic blocks, previously not addressed, added as investigational. Radiofrequency denervation for treatment of chronic spinal/back pain is medically necessary when criteria are met. For all other uses that do not meet the policy criteria RF denervation is investigational. If there has been a prior successful radiofrequency denervation, additional diagnostic medical branch blocks for the same level of the spine are considered not medically necessary. February 2012 Alaska Network News 11

Premera Blue Cross Blue Shield of Alaska P.O. Box 327 Seattle, WA 98111 PRESORTED STANDARD U.S. POSTAGE PAID SEATTLE, WA PERMIT NO. 2944 Please post or circulate this newsletter in your office Network News Back issues of Network News are on our web site at premera.com/provider in the Library under Communications. 12 February 2012 Alaska Network News 012335 (02-2012) DR 3606