1st Quarter 2010.indd - Blue Cross and Blue Shield of Louisiana
Contents
1. BCBS s Blue Surgical Safety Checklist is a resource for hospitals and physicians It was adopted from the World Health Organization WWHO Surgical Safety Checklist and is available online at www bcbs com then click on Blue Resources gt Health amp Wellness gt Blue Surgical Safety Checklist The checklist outlines essential standards of surgical care and is designed to be simple widely applicable and address common and potentially disastrous lapses in care We at Blue Cross and Blue Shield of Louisiana are encouraging our hospitals and physicians to use this checklist We are also educating and encouraging our members to share this checklist with their healthcare team prior to surgery The goal is to improve surgical results and decrease risk to patients Having an open discussion with your patients about surgical safety is one way you can proactively promote safety and help eliminate avoidable complications which helps patients receive the highest standard of surgical care Hospitals may also register with WHO as a facility that is interested in promoting and implementing a surgical safety checklist in their operating rooms Visit www who int patientsafety safesurgery en for more information If you have any questions or would like additional information please contact Ms Kim Gassie at Kim Gassie bcbsla com or 225 297 2685 ow To ensure that claims are not rejected for an NPI we request that prov2. anything Your Health Gur Comeniimant zf ymu 1 ae M ee ey mard te ee E BLUES NEWS From time to time new messages will be added here regarding current Blue Cross events and highlights Health Plan Payment Summary Shows the member s financial responsibility if any using easy to follow calculations from the visit phone number mailing address or website to contact Blue Cross and Blue Shield of Louisiana Health Plan Benefits At A Glance Here members is able to view how much of their deductible amount has been satisfied and total out of pocket expenses for the present year and for a previous year in some cases hea ea e naa BrT pii ig Copayment Coinsurance Copayment is the fixed dollar amount the member pays for certain covered services Coinsurance is a fixed percentage the member pays for certain covered services www bcbsla com e Provider Directory Enhancements e Updated Professional Provider Office Manual available under Manuals and Speed Guides e Healthcare reform updates at www bcbsla com reform e Updated Credentialing Section is coming soon www bcbsla com ilinkblue e Updated manuals including the Member Provider Policies and Procedures Manual e ITS Out of Area claims status has been added as a new section under Claims Research Updated BlueCard
3. A publication to keep our network providers up to date on the latest news at Blue Cross and Blue Shield of Louisiana network 1st Quarter 2010 providing health guidance and affordable access to quality care INSIDE THIS ISSUE Provider Network 2 Blue Surgical Safety Checklist 2 NPI Only by Mid 2010 3 What s the Latest on Your Contact Info 3 Medicare Changes Payment Rules for Consultation Services 3 Availability Standards for Blue Cross Providers Billing amp Coding 4 Coding of the Future ICD 10 Reasons for Change to ICD 10 Updated Anesthesia Billing Guidelines 99231 Instead of 01999 Blue Cross Updates CPT amp HCPCS Codes HMOLA Lab Program 5 Help Your Patients Protect Their Medical Identity Electronic Services Blue Health Record Use iLinkBLUE for Imaging Auths AIM Call Center Holidays Enhanced Screens in iLinkBLUE Use iLinkBLUE to View Your Allowables BlueCard Out of Area Tool in iLB Out of State BlueCard Program 7 Medicare Advantage Quick Guides BlueCard Quick Tips Extended Runout for USVI Automating Medical Records Guidelines for Submitting BlueCard Medical Records Medical Management 8 Blue Cross Manages Imaging Authoriazations for Select Groups 8 Pre authorization Hints 8 Favorable Medical Policy Survey Results 9 Medical Policy Update Company News 10 Free Precriptions With CopyCats 10 Edison Chouest Offshore Chooses Blue Cross 10 Blue Cross Awarded OGB Con
4. authorizations directly to AIM American Imaging Shield of Louisiana patients and get the whole picture fast It is your quick reference guide to e current and past prescriptions filled e illnesses and associated treatments e surgeries performed e immunizations and preventive healthcare received within the last two 2 years To learn more on how to access members Blue Health Records please e mail EDI Services at ilinkblue providerinfo bcbsla com or call the LINKLine at 800 216 BLUE 2583 This tool is available on iLinkBLUE our online provider resource www bcbsla com ilinkblue These records are useful for treating new patients as well as patients with complex health issues and chronic diseases Facilities can also benefit from the use of Blue Health Records when treating emergency room patients We do require that Enhanced Screens in iLinkBLUE On February 2 2010 we implemented enhancements to the Electronic Funds Transfer EFT and Remittance Advice screens The functionality and layout have changed slightly to make research and viewing payment information more convenient and user friendly Also as part of the enhancements iLinkBLUE now archives a maximum of two years of remittance advices and EFTs More on these enhancements is available on the iLinkBLUE message board providers limit access to this sensitiv
5. developed by the Centers for Disease Control and Prevention Tips to Prepare for ICD 10 Compliance CDC that is formatted much like the ICD 9 system of codes It CMS suggests that provider organizations and facilities develop a plan for implementing the upcoming ICD 10 code changes Providers should start reaching out now to their information technology system vendors medical management software vendors trading partners etc will however use a different number of digits and will be used in all healthcare treatment settings A few tips for making the change to IDC 10 coding include ICD 10 PCS e Assess the impact of converting to ICD 10 codes e Develop a strategy for implementing system changes including testing and ICD 10 PCS is a procedure go live dates classification system of codes e Evaluate and prepare for any financial impacts this change may create developed by CMS to be used to e Develop a plan for training your employees on this change report procedures performed in an e Acquire any necessary resources to implement your transition to ICD 10 inpatient hospital setting only ICD 0 PCS codes will consist of seven alpha or numeric digits compared More on ICD I0 to the ICD 9 CM procedures codes which currently only use three or four numeric codes CMS offers more information on the change to ICD 10 coding e ICD 10 Overview www cms hhs gov ICD 0 e Diagnosis and Procedure Codes Fact Sheet www cms hhs gov MLNP
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7. HCPCS codes are released Blue Cross adds them to our system for the purpose of processing claims In addition to adding new codes throughout the year on January Ist of each year our largest system update we also update the allowable charges for existing CPT and HCPCS codes Allowable charges for CPT codes are available in iLinkBLUE by selecting Allowable Charges on the left menu bar Using this tool providers have the option to research allowable charges by applicable network then by a single or range of CPT codes with or without modifiers A complete list of allowable charges for our HCPCS codes is available in iLinkBLUE Click on Manuals on the menu bar then on Allowable Charges to view PDFs listings of HCPCS allowable charges Providers without access to iLinkBLUE may call Provider Services at More information is available in our 800 922 8866 to request allowable charges or a listing of our HCPCS allowable HMOLA Preferred Lab Program Speed charges Guide This speed guide fully outlines the HMOLA Preferred Lab Program and is available under the Manual amp Speed Guides section of our Provider page at We recently added the following new codes to the Diagnostic and Therapeutic CPT HCPCS code range 0203 T 0204T 92570 G0430 G043 i 0206T 0218T A958 1 A9583 G9141 The HMOLA Preferred Lab Program 90470 A9604 Q01 38 Speed Guide also includes a complete list 92540 C9254 C9257 Q4074 of in office lab services that
8. Implantable Hormone Pellets 00210 Erythropoiesis Stimulating Agents ESAs Darbepoetin Arnesp H P Acthar Gel Cancer Screening Epoetin Epogen and Procrit and 00230 Repository Corticotropin Injection ACTH Gel 00230 Computed Tomography Scanning for Lung 10 Provider Network News Ist Quarter 2010 Company News We now offer members the opportunity to try select generic alternatives for FREE Our COPYCATS program gives members a one time first fill for free on specific generic drugs Generics are copycats of brand name drugs They are safe effective and typically cost a quarter of the price of brand name drugs They are U S Food and Drug Administration FDA approved and must meet the same strict standards as brand name drugs When you prescribe a generic medication included in the Trial Program we ll give the member their first fill for free The member s first free fill for an eligible generic drug is determined at the point of fill at the pharmacy Members already established on an eligible generic drug do not qualify as it would not be their first fill COPYCATS is not available for pharmacy benefit designs that feature a deductible and coinsurance For self insured groups participation is optional Edison Chouest Offshore Chooses Blue Cross We are pleased to announce that Edison Chouest Offshore a self insured group has chosen Blue Cross and Blue Shiel
9. and is the industry standard for this service Effective Feb 2010 we have updated our system to utilize 99231 for IV PCA daily management claims We no longer accept the unlisted CPT code 01999 for use when billing IV PCA daily management claims The allowable charge for 99231 will be the basis for your reimbursement as your set up charge is now included as part of the Evaluation and Management HMOLA Lab Program allowance of the daily management and should not be billed separately Providers participating in our HMO Billing anesthesia minutes anesthesia modifiers or physical status modifiers Louisiana Inc HMOLA provider with 99231 is not appropriate If billed with 99231 a delay in payment or non payment may occur For more information see the Anesthesia Billing Guidelines in your Professional Provider Office Manual network must follow the guidelines of our Preferred Lab Program in order to receive the highest level of reimbursement for laboratory testing and to assure your HMOLA patients receive the appropriate Blue Cross Updates CPT amp HCPCS Codes level of benefits Under the HMOLA lab program participating HMOLA providers are only reimbursed for select lab services when performed in the office All other lab services should be sent to one of our HMOLA lab vendors e LabCorp e Omega Diagnostics e Quest Diagnostics e Woman s Hospital for the Baton Rouge area select services only Each year as new CPT and
10. copyright 2010 American Medical Association All rights reserved Availability Standards for Blue Cross Providers Blue Cross is committed to providing access to high quality healthcare for all members promoting healthier lifestyles and ensuring member satisfaction with the delivery of care To support these commitments network providers are responsible for meeting the following availability standards e Emergency Immediate access 24 hours a day 7 days a week Defined as medical situations in which a member would reasonably believe his or her life to be in danger or that permanent disability might result if the condition is not treated Examples include loss of consciousness seizures chest pain severe bleeding or trauma etc Urgent 30 hours or less Defined as medical conditions that could result in serious injury or disability if medical attention is not received These conditions are not considered life threatening but do substantially restrict a member s activity Examples include severe or acute pain high fever in relation to age and condition etc Routine Primary Care Non urgent symptomatic visits 5 to 14 days Defined as problems that could develop if left untreated but do not substantially restrict a member s normal activity Examples include backache suspicious mole etc Preventive Care 6 weeks or less Examples include routine physical well baby exam annual Pap smear etc 4 Provider Network News Ist Qua
11. of Area tool e By calling BlueCard Eligibility at 1 800 676 BLUE 2583 Submit BlueCard claims e Directly to Blue Cross and Blue Shield of Louisiana Check BlueCard claim status e Via your electronic remittance advices available in iLinkBLUE e Using iLinkBLUE s BlueCard Out of Area tool e Calling Provider Services at 800 922 8866 Blue Cross and Blue Shield of Louisiana is working to implement a new internal process for routing medical records This new process will be seamless to providers There will be no change in the way providers submit medical records However providers should notice improved response times due to a more efficient internal process The initial implementation of automating medical records is scheduled for implementation in early 2010 and will include BlueCard claims Medical records will be processed and imaged in one centralized location then routed via an automated process to their destination resulting in quicker reviews which means quicker processing of claims that require medical records for adjudication Part of this new process includes adding functionality by way of an additional search engine within the application where imaged medical records will be securely stored allowing us to easily locate and review the medical records that you submit The new functionality will also help to reduce duplicate requests and provide our customer service representatives with the tools needed to accurately se
12. the PHS include z A health plan payment summary that provides payment details of the member s most recent claim Cj Contact information for Blue Cross customer service z The member s health plan benefits at a glance This section shows the deductible out of pocket maximum and lifetime maximum amounts and how much of each has been satisfied z A Blues News box with company updates and highlights that can be changed periodically as needed Cj Visit Details including e service dates e total amounts charged by the provider e member discounts applied e charges not covered e exclusions e deductibles and copayment coinsurance information Cj A breakdown of Blue Cross and subscriber payments due g Pharmacy details such as prescribed drug strength and quantity Ist Quarter 2010 Provider Network News _ Member Benefits THIS IS NOT A BILL JENNIFER C SMITH 123 YOUR STREET YOUR City ST 95009 pi0a Your total medical dental services anid Member dicount amour Not Covered Amount Your health planis paid TOTAL AMOUNT YOU OWE PROVIDERS Ill ul th sla laa lal val ih ili D sla sla laa lal bad ill val val BLUES NEWS you should do next re y Bra a Heilo JENNIFER C SMITH HEALTH PLAN PAYMENT SUMMARY November 25 7009 shough November 25 2009 Page iol d 3163722 TOURA CUSTOMER INFORMA THOM Tour Employer Bue Cross Blue Shieid of Lousiana 0 00 Your Group ith 1258
13. 78 WED LOVE TO HEAR FROM YOU 0 00 Call 1 H 495 7583 B00 am 5 00 pom Monday Friday chee Biue Crosa and Blue Shap of Loutsaana 814 04 rca ERSA Contact Us Wet han iiwww bobsla comieniinahelp Members may use this HEALTH PLAN BENEFITS AT 4 GLANCE Biwo Cross and Blue Shioid of Louisiana A alijanna jl Pan Cee mai Pham ede Aaaa aiir BESE pid Service Date Total Amount Charged Member Discount Not Covered Amount The date The total amount charged The amount the Any portion of the submitted medical by a healthcare provider member saved by charges not covered by the services were whether or not the receiving services member s benefit plan The incurred services are covered from a network provider is responsible for healthcare provider these charges Eei Ta VEUR PATSHA mikes TH A ne OEP if Exclusions Any portion of the submitted charges not covered by the member s benefit plan Member is responsible for these charges HM Louisiana Inc A aida po Ako Dami ae Ba ee i i oa Teepe ed ma of ra bis Crome erat Doe Lees nao TAS HEAL Tis FLARE Pa i em ma mas uw Yini iagt piisa jim J DO Pal a7 of Deductible The fixed dollar amount the member pays for covered services before benefits are available Viieloome io your new Health Statement which heplaces iha EBs you ued bo neasa Thee Health Statement bets you whats boan paid whan you may owe and why and what
14. More About Healthcare Reform Visit http americanhealthsolution org blog to get daily blog updates on the progress of reform and read important Fact Check fact sheets to help you understand the issues www bcbsla com www bcbsla com ilinkblue BlueCross BlueShield Vy of Louisiana An independent licensee of the Blue Cross and Blue Shield Association 2 Provider Network News Ist Quarter 2010 Over the last two years we have communicated the need for providers to submit their National Provider Identifier NPI as it will soon be a requirement for filing claims By mid 2010 Blue Fo j Cross will require an NPI on all claims both electronic and paper h mee Ta a regardless of the provider s network participation Providers will receive a 30 day notice before we transition to accepting NPI only on claims Once the transition is made to NPI only claims received without an NPI or with an NPI that is not on our records will be rejected Every operating room team can improve the safety and efficacy of care delivered to surgical patients Blue Surgical Safety Checklist Surgery is often an essential component of healthcare yet many surgical complications are common and preventable The Blue Cross Blue Shield Association BCBS is taking a leadership role in identifying opportunities to support improvements in healthcare delivery and safety for Blue members in operating rooms across the nation
15. Out of Area User Manual Have an Idea NetworkNews is your newsletter designed to serve you our valued network providers The views of our readership are important to us If you have ideas for articles or suggestions about how we can improve this newsletter please e mail us at provider communications bcbsla com What s New on the Web Network News Network News is a quarterly newsletter for Blue Cross and Blue Shield of Louisiana network providers We encourage you to share this newsletter with your staff The content in this newsletter is for informational purposes only Diagnosis treatment recommendations and the provision of medical care services for Blue Cross members are the responsibilities of healthcare professionals and facility providers If you would like to receive this newsletter by e mail please contact us at provider communications bcbsla com View the newsletter online at www bcbsla com gt Provider gt Provider News Important Contact Information Authorization Fraud amp Abuse See member s ID card 1 800 392 9249 BlueCard Eligibility fraud bcbsla com 800 676 BLUE 2583 iLinkBLUE amp EFT Claims Filing 800 2 16 BLUE 2583 P O Box 98029 Baton Rouge LA 70898 iLinkBLUE Providerlnfo bcbsla com Network Administration EDI Clearinghouse 1 800 716 2299 Fax 225 297 2750 1 225 291 4334 network administration bcbsla com EDICH bebsla com Provider Services Call Center FEP 800 922 8866 800 272
16. are payable 92550 G0422 G0424 Q9768 under the member s copayment when We added the following new codes to the Surgical CPT HCPCS code range performed in the office 0221 1 0222T CPT only copyright 20 10 American Medical Association All rights reserved Help Your Patients Protect Their Medical Identity According to the Federal Trade Commission an estimated 200 000 people a year are victims of medical identity theft Medical identity theft happens when someone uses another person s name and other parts of their identity to obtain medical services or to file false claims for medical services The effects can be devastating to the victim s financial and medical records Medical files might list the wrong blood type diagnosis or incorrect prescriptions Help prevent medical identity fraud by properly identifying patients If you encounter someone using a Blue Cross ID card frauduently please contact our Fraud Hotline at 1 800 392 9249 or e mail fraud bcbsla com 6 Provider Network News Ist Quarter 2010 Electronic Services Use iLinkBLUE for Imaging Blue Authorizations Health Record With just a few clicks of the mouse you can retrieve a claims based health record for most of your Blue Cross and Blue Quick access to a patient s complete medical history Did you know that you can request imaging authorizations online anytime of day Through iLinkBLUE ordering physicians can submit electronic requests for imaging
17. asure medical policy consistency among its family of Blue Plans This effort was viewed as an important aspect of the BCBS System in terms of improving customer i e physician member and national account satisfaction The effort to improve consistency of medical policies among Blue Plans has been in place for the past two years 2008 2009 and the overall survey result average for all 37 participating Blue Plans is 82 7 percent Blue Cross and Blue Shield of Louisiana s 2009 goal was to achieve 85 percent consistency for our medical policies when compared with BCBS s medical policies For 2009 we achieved a consistency of 87 percent Dr Thomas Kim director of medical policy for BCBSLA continues to focus on this effort for 2010 It is important to not only achieve but also to maintain and continue to improve the standard of consistency for our medical policies says Kim Although the methodologies of the surveys in 2008 and 2009 were not identical the results of the 2009 survey showed significant improvement compared to the 2008 survey for both the overall results for all Blue Plans as well as BCBSLA s results BCBS plans to conduct their medical policy consistency survey again in 2010 Ist Quarter 2010 Provider Network News 9 ki Blue Cross regularly develops and revises medical policies in response to rapidly changing medical technology Our commitment is to update the provider community as medical policies are adopted and o
18. by having the following information handy e Your NPI number office address and telephone number e The patient s full name policy number and date of birth e The diagnosis and procedure codes e The place where services will be rendered void calling on Monday whenever possible Mondays are often busier due to i weekend utilization activity If you must call on a Monday please expect slightly longer hold times tilize our electronic provider resources whenever possible e Our list of specialty drugs that require authorization is available at e Medical Policies are available on iLinkBLUE e Our network speed guides and provider manuals include a list of services that require authorization and are available under the Manuals and Speed Guides section of the Provider page at www bcbsla com e You can request and view high tech imaging authorizations online through iLinkBLUE which links you directly to AIM urnaround time is within three 3 to five 5 calendar days for non urgent authorization requests Promptly respond when additional medical information is requested to prevent delays elp us serve you faster by requesting an authorization extension before the patient s current authorization expires ubmit authorization requests via Fax to 800 586 2299 when possible Medical Policy Consistency Survey Results As a pro competitive and pro consumer initiative the Blue Cross and Blue Shield Association BCBS has adopted efforts to me
19. d of Louisiana as their health plan administrator Located in Galliano La this company represents the most diverse and dynamic marine transportation operation in the world The company owns and operates a growing fleet of new generation offshore service vessels supporting a vast majority of the U S Gulf deepwater market as well as a large independently owned fleet of research vessels Edison Chouest Offshore has more than 4 000 employees nationwide with nearly 2 000 employees residing in Louisiana As of January 2010 these Louisiana employees and their dependents now have access to our Preferred Care PPO network providers and hospitals Edison Chouest Offshore members ID cards carry the Galliano Marine Service LLC name in addition to the BCBSLA logo oun a SM saint bine Benefits and eligibility information is available ORES through iLinkBLUE You may also contact Provider me asia Services at 1 800 922 8866 with questions regarding I _ ST sewon this group BlueCross BlueShield of Louisiana SH are pence rh Bee Se dt a et Snub rptet 4a Le attr ip Deducthtie ki Ciria Fria Al thie Poia Blue Cross Awarded OGB Contract for HMO Blue Cross and Blue Shield of Louisiana was among several health plan carriers that submitted bids to administer HMO benefits for state employees We are pleased to announce that we have been awarded the contract to administer the self insured HMO health plan for the Office of Group B
20. e information and recommend that only physicians and designees of physicians responsible for patient care request access to the Blue Health Record Management Simply click on Authorizations on the iLinkBLUE menu bar then select Imaging Authorizations AIM A step by step tutorial on using AIM s web portal is also available on iLinkBLUE AIM Call Center Holidays AIM s call center will be closed on the 2010 holidays listed below Ordering physicians may still obtain imaging authorizations by using AIM s interactive web portal available through iLinkBLUE Memorial Day Monday May 3 Independence Day Monday July 5 Labor Day Monday Sept 6 Thanksgiving Thursday Nov 25 Day after Thanksgiving Friday Nov 26 Christmas Eve Friday Dec 24 AIM is an independent company that serves as the high tech imaging authorization manager for Blue Cross and Blue Shield of Louisiana and HMO Louisiana Inc Use iLinkBLUE to View Your Allowables If you re not already using iLinkBLUE to get your allowable charges now is the time to start With iLinkBLUE you can get allowable charges by network date of service and even code range Go to www bcbsla com ilinkblue and look for Allowable Charges on the menu bar If you re not an iLinkBLUE user more information on becoming a user is available under the iLinkBLUE section of our Provider page at www bcbsla com BlueCard Out of Area Tool i
21. enefits OGB Effective July 1 2010 OGB plan members who choose the HMO health plan will have access to our extensive Preferred Care network of doctors hospitals and other medical care providers as well as Blue providers nationwide Having access to medical care across the U S is key for retirees who live in other states and also for employees and retirees with children attending out of state colleges and universities explained OGB chief executive officer Tommy D Teague The national network Blue Cross will provide for our HMO plan eliminates the need for a separate EPO plan Teague said OGB is merging their current HMO plan with their self insured Exclusive Provider Organization EPO health plan and HMO plan members will be served by our extensive Preferred Care provider network Follow Blue Cross on Facebook amp More Do you like getting information online through social media sites like Facebook or Twitter Blue Cross and Blue Shield of Louisiana has established accounts on several of the most popular social websites where we are providing information on wellness and disease prevention healthcare reform issues company news and much more iena A Become a fan at www facebook com bluecrossla e Follow our CEO Mike Reitz at www twitter com MikeReitzCEO twitter 2 e Follow our corporate Twitter feed at www twitter com BCBSLA You Tube e See our video messages at www youtube com bluecrossla Features of
22. iders submit their NPI to us before the switch to NPI onlly Below are three ways to submit your NPI to Blue Cross Provider Update Form Submit it using our Provider Update Form available under the Forms for Providers section of our Provider page at On Your Letterhead Print your name and tax identificaton number TIN or social security number on your office letterhead and fax to 225 297 2750 or mail to BCBSLA Attn Network Administration PO Box 98029 Baton Rouge LA 70898 9029 Credentialing Recredentialing Forms Include it on your Louisiana Standardized Credentialing Application LSCA Health Delivery Organization HDO Application or Blue Cross recredentialing application Failure to include an NPI during the credentialing or recredentialing will delay the process until we receive the NPI s If you are employed by or affiliated with a clinic and your payments are made directly to that clinic then both you as an individual provider and the clinic are responsible for obtaining separate NPls You should then notify Blue Cross of both your NPI as well as the clinic NPI Always remember to file claims with both NPIs and your TIN Facilities that choose to use the same NPI for all of their hospital based subunits should notify Blue Cross so we can load the NPI on all subunit records If you choose this option then you must file your claims with taxonomy codes in addition to the NPI and TIN Ist Quarter 2010 P
23. in until as late as 2014 In addition Republican lawmakers may file new federal legislation to Blue Cross Awarded OGB Contract Page 10 try to repeal the healthcare reform law or to negate parts of it Several states attorneys general have filed suit alleging the new law is unconstitutional and other states legislatures are considering bills that would prohibit state agencies from complying with the federal mandates As you can see we must continue to monitor the ongoing debate We know that healthcare reform is confusing even for those of us in the industry and we promise to do our best to get you and your patients the answers you need on the questions about reform This is a confusing time for all Americans and we expect that many of you may be receiving questions from your patients staff members friends and family Blue Cross values our relationships with hospitals physicians and allied providers and recognizes the value our robust healthcare networks bring to our members It is on their behalf that we must work with our key business partners including doctors and hospitals employers legislators and consumers to ensure that the reforms passed by Congress work for the people of Louisiana We will keep our own healthcare reform web page as up to date as possible over the next few weeks and months Go to www bcbsla com and click Healthcare Reform to follow developments as we understand them Learn
24. n iLinkBLUE iLinkBLUE includes a tool that allows you to request eligibility limited benefits and claim status for BlueCard members It is located in the navigational menu under the BlueCard Out of Area option To help providers use this tool we have added a step by step user manual to the Manuals section of iLinkBLUE Check it out iLinkBLUE is available at www bcbsla com ilinkblue Maad pees Pike he tl ii ma wl Lenton Lo le a e wama PFS ee Our newly developed provider quick guides for Medicare Advantage PPO and PFFS are now available under the Manuals and Speed Guides section of our Provider page at _ ee EC n mii p l m a a a s vis i ra m ani an Sli Seber ell p i a ma p a Extended Runout Period for US Virgin Island USVI Claims Claims for services incurred for USVI members on or before June 30 2009 will continue to be processed by Independence Blue Cross through April 16 2010 This is an extension from the original January 31 2010 claims runout date Extending the claims runout date will help provide continuity to providers Services incurred for USVI members on and after July 01 2009 will be processed by Triple S Salud of Peurto Rico via BCBSLA s BlueCard Program BlueCard Quick Tips Check BlueCard member eligibility benefits and authorization information e Using iLinkBLUE s BlueCard Out
25. r revised Benefit determinations are made based on the medical policy in effect at the time of the provision of services Please view the following updated medical policies all of which can be found on iLinkBLUE at These symbols are referenced next to medical policies listed on this page and indicate Blue Cross coverage indications as follows Y 00244 Vigabatrin Sabril Dec 16 2009 00245 Genetic Testing for Warfarin Dec 16 2009 Dose 00246 Ventricular Assist Devices Jan 20 2010 and Total Artificial Hearts 00247 Electromagnetic Navigation Jan 20 2010 Bronchoscopy Policy No 00244 Vigabatrin Sabril 00248 Adoptive Immunotherapy Feb 17 2010 Vigabatrin Sabril is a recently FDA approved 00250 Biomarkers for Detection Feb 17 2010 medication for two indications The pediatric indication of Lymph Node Metastases is for infantile spasms a difficult to treat seizure in Breast Cancer disorder that strikes infants between three to six months of age The adult indication is for complex 0025 1 Ultrasonographic Measurement Feb 17 2010 partial seizures that do not respond to first line agents of Carotid Intimal Medial For infantile spasm this drug is the first FDA approved Thickness as an Assessment agent for this syndrome although a repository of Subclinical Atherosclerosis corticotrophin ACTH gel has been used in the past The precise mechanism of this drug is unknown and available in oral solution and tablet forms 00073
26. roducts downloads ICD Ofactsheet2008 pdf e GEMS General Equivalence Mappings Fact Sheet www cms hhs gov MLNProducts downloads ICD OMappingfctsht pdf e GEMS Frequently Asked Questions FAQs www cms hhs gov MLNProducts downloads ICD 10_GEM_factsheet pdf Updated Anesthesia Billing Guidelines Included in Our Online Provider Manuals We recently made updates to our anesthesia billing guidelines P r Policing ies Mamber Pirn ier effective Feb 2010 and they are available in our Professional r Seed Ares Manus Provider Office Manual and Member Provider Policies amp Procedures Manual You can always find our provider manuals under the Manuals amp Speed Guides section of our Provider page at www bcbsla com The Member Provider Policies amp Procedures Manual is available only on iLinkBLUE ee Ist Quarter 2010 Provider Network News 5 Billing and Coding IV PCA Coding Change 99231 Instead of 01999 In response to concerns from our anesthesia providers over the need to appeal claims especially when treating Out of State BlueCard members for IV PCA daily management and billing CPT code 01999 we researched an alternative billing procedure Our research determined that it is more appropriate to bill Evaluation and Management code 99231 instead of 01999 This billing practice is also the recommended coding by the American Society of Anesthesiologists ASA
27. rovider Network News 3 Provider Network What s the Latest on Your Contact Info Did you know that each year Blue Cross and Blue Shield of Louisiana is ranked against all other BlueCross BlueShield Plans on the accuracy of our provider directories Having accurate directories ensures that our members your patients are able to locate you when they need healthcare If you have recently moved changed your phone number s fax number s or e mail address etc and have not notified us it is important to notify us so that we can accurately publish your contact information There are several ways that you may notify us of your updated contact information e Complete our online interactive Provider Update Form available under the Forms for Providers sections of our Provider page at www bcbsla com Send an e mail to provider communications bcbsla com Be sure to include the name and NPI of the provider a contact name and telephone number Contact Blue Cross Provider Network Administration Division at 800 716 2299 option 3 Include it on your recredentialing form during your recredentialing process Medicare Changes Payment Rules for Consultation Services In 2009 the Centers for Medicare amp Medicaid Services CMS announced that effective January 2010 Medicare will no longer recognize consultation CPT codes 99241 99245 and 99251 99255 This applies for both Medicare primary and Medicare secondar
28. rter 2010 Billing and Coding Reasons for Change Coding of the Future ICD 10 to ICD 10 The Centers for Medicare and Medicaid CMS has mandated the conversion from eE E acts Pheer ie diagnosis and ICD 10 PCS hospital procedure code 30 years old and has outdated and obsolete terminology It is also These mandates may require substantial changes to the information technology i l i l systems for health insurers providers clearinghouses and practice management inconsistent with current medical vendors Differences in code length alpha numeric characters and increased details practices captured by the codes are just some of the changes that are a part of the new code The conversion to ICD 10 codes set will allow for necessary details on All healthcare organizations must also be compliant with American National patient medical conditions and on Standards Institute ANSI Transaction Version 5010 ANSI v5010 and the National procedures performed during a Council for Prescription Drug Programs standard Version D 0 for electronic patient s hospitalization transactions such as healthcare claims by January 2012 Version 5010 is essential to the use of the ICD I0 codes ICD 10 CM The CMS website includes a section dedicated to ICD 10 and how it differs from ICD 9 www cms hhs gov ICD 10 Check this site often for upcoming ICD 10 CM is a diagnosis presentations helpful downloads and other updated information classification system of codes
29. rvice the provider during a call You can also help in maximizing the efficiency and effectiveness of this new automated process by following the guidelines for submitting medical records to BCBSLA at right Ist Quarter 2010 4 Provider Network News 7 Always submit medical records directly to BCBSLA when you receive a Medical Record Request Form from BCBSLA Wait until you receive a request for medical records from Blue Cross before submitting medical records for any denial or notification for e lack of information received e additional information needed e waiting on requested information For these types of denials providers should wait ten 10 business days to allow BCBSLA time to send out a request for medical records If after ten 10 business days no request is received the provider should inquire with customer service to verify exactly what information is needed Promptly send medical records to BCBSLA within ten 10 business days after receiving a request for medical records Always include the Request for Medical Records Form that you received as the cover or first page of the records With a copy of the originally filed claim as an attachment Unless you received a request for medical records from BCBSLA Without the Request for Medical Records Form attached Via certified mail Upon receipt of medical records please allow 30 days for Blue Cross and or the member s Blue Plan to comple
30. te the review process If no response is received after 30 days please follow up with BCBSLA by calling provider services at 800 922 8866 8 Provider Network News Select self funded groups that use Blue Cross and Blue Shield of Louisiana as their health plan administrator have opted not to use AIM s radiology management program for imaging authorizations For the following groups imaging authorizations will be managed directly by Blue Cross Group No 78477 ERC 77890 FF4 77376 77678 FF4 78340 ERC 75574 FF4 77307 483 18 FF2 78022 FF4 77068 FF4 48214 72201 72279 77889 Group Name Acadian Ambulance CGB Enterprises Inc Calcasieu Parish School System Danos amp Curole Marine Contractors LLC Green Energy Services Lafayette Parish School Board McGlinchey Stafford Petroleum Helicopters Inc Phelps Dunbar Rubicon LLC Sewerage amp Water Board of N O Sheriff s Association Zen Noh Grain Corporation To obtain imaging authorizations for these BCBSLA members call Provider Services at 1 800 922 8866 option 2 Ist Quarter 2010 Pre authorization Hints vB Follow these tips to simplify your authorization process Prepare organize and document all necessary information before calling or faxing your request equest eligibility and benefit coverage for your patient before hand by using iLinkBLUE or calling the customer service number on the member s ID card xpedite your call
31. tract for HMO 10 Follow Blue Cross on Facebook amp More Member Benefits PHS Replaces EOB uo BR BR BA Oo OY O O O O Ui N NNN oe J gb ed Gd join the march start a team or be a sponsor http marchforbabies org march of dimes 23XX6753 RO3 1 Tips to Prepare for ICD 10 Compliance Healthcare Reform On March 21 the U S House of Representatives passed the Patient Protection and Affordable Care Act PPACA otherwise known as healthcare reform by a vote of 219 to 212 President Obama signed that bill into law on March 23 The Senate then passed the so called reconciliation bil that was required to add certain fixes to the healthcare reform legislation and sent it back to the House with slight changes Finally the House passed the reconciliation bill on March 25 sending it to the president to sign While healthcare reform is now the law of the land it is difficult to know yet exactly what shape the final details will take Many analysts all over the country in the insurance industry hospitals doctors organizations legal experts and more are studying the massive new law and attempting to boil it down into understandable points Here at Blue Cross we have been monitoring the healthcare reform debate for months and we will continue to do so The new law will take effect in stages Some provisions take effect within 90 days or six months while others don t kick
32. y claims These codes are still valid CPT codes for 2010 and Blue Cross continues to accept these consultation codes We have current allowable charges for these codes and any changes in allowable amounts or billing policies for these codes will be communicated to our providers with a 90 day notice At this time we do not anticipate any changes Per CMS physicians and others must bill an appropriate Evaluation and Management code for the services previously paid using the consultation codes If the primary payer for the service continues to recognize consultation codes physicians and others billing for these services may either Bill the primary payer an Evaluation and Management code that is appropriate for the service and then report the amount actually paid by the primary payer along with the same Evaluation and Management code to Medicare for determination of whether a payment is due or 2 Bill the primary payer using a consultation code that is appropriate for the service and then report the amount actually paid by the primary payer along with an Evaluation and Management code that is appropriate for the service to Medicare for determination of whether a payment is due Note The first option may be easier from a billing and claims processing perspective For more on this from CMS go to www cms hhs gov MLNMattersArticles downloads MM6740 pdf and www cms hhs gov MLNMattersArticles downloads SE 010 pdf CPT only
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