FOR HEALTHCARE PROFESSIONALS

oneone TO

WINTER 2015

Blue Cross of Idaho Introduces Mobile AppBlue Cross of Idaho is in the process of releasing a new mobile app for smartphones designed to give members on-the-go access to their key health insurance information.

Once members log in using their bcidaho.com member account, they can search for providers, hospitals, clinics and urgent care closest to wherever they are. They can also see specifics about their benefits, including copayments, coverage and even see how much they have paid toward their yearly deductible.

Members will also have the option of viewing their member ID cards, which they can then send via email or fax directly to a chosen provider. These member ID cards will be sent through Clarity, our vendor who handles all our ID card requests. Both emails and faxes will include an introduction or cover sheet stating that the card has been sent at the request of a Blue Cross of Idaho member.

When sending ID cards, the address or phone number field will be automatically filled in with the most recent information we have on file. While members are encouraged to verify the information, this makes it even more important for providers to make sure they have the most up-to-date contact information available.

Please watch for these member ID cards being sent through this new system. If you should have any problems receiving ID cards through this system, please email us at mobileapphelp@bcidaho.com.

The Blue Cross of Idaho mobile app is free for download and will be available at both Apple iTunes and the Google Play app stores. You can learn more about the app at bcidaho.com/mobileapp.

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Medicare Advantage Becomes Care PlusWith a new year brings a new look. Medicare Advantage is now a part of Blue Cross of Idaho Care Plus. It’s the same great True Blue and Secure Blue plans you already know, with all services provided by Blue Cross of Idaho, just with a new logo.

Take Care with High-Risk Medications in Older PatientsIn 2012, the American Geriatric Society (AGS) published updated guidelines for potentially inappropriate medication use in older adults in the AGS 2012 Beers Criteria.

These guidelines are highly regarded across the industry, and have been the basis for other recommendations and quality scores including the Pharmacy Quality Alliance (PQA) Use of High Risk Medications in the Elderly and the CMS Star Ratings.

To support the safety of our members and discourage use of high-risk medications, many of these medications have had their Medicare Part D formulary status updated in 2015.

The use of high-risk medications in patients age 65 and older has continued to be a cause for concern. We have recently had several requests for additional information regarding these high-risk medications and have included links to clinical guides below. We encourage your review and use of these guides when evaluating a member’s risks and benefits when prescribing medications.

Blue Cross of Idaho 2015 formulary and plan information: bcidaho.com/medicare/2015/resources.asp

A printable pocket guide to high risk medication in older adults: americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf

Full AGS 2012 Beers Criteria: americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf

The Beers Criteria outlines medications which should not be used, medications to be avoided with specific diseases or syndromes, as well as medications that should only be used with caution. Each recommendation includes rationale, the quality of evidence, and the strength of the recommendations to better assist you in your care decisions.

Consider reviewing a member’s medications at least once a year by having him or her bring all prescription and over-the-counter medication bottles to his or her appointment.

Top 10 high-risk medications for adults age 65 and older (by Blue Cross of Idaho fill rate) n zolpidem

n nitrofurantoin

n estrogens (with or without progestin)

n amitriptyline

n digoxin (>1.25mg/day)

n cyclobenzaprine

n Armour thyroid®

n glyburide

n doxepin

n carisoprodol

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It’s Time for HEDIS®

Blue Cross of Idaho Quality Management staff will be contacting and visiting area healthcare providers this spring to conduct the annual Healthcare Effectiveness Data and Information Set (HEDIS®) audit. We will review information for select measures from 2014 or prior years.

As part of the HEDIS® audit, we collect a standardized set of quality indicators covering a range of services addressing important health issues including preventative health services, chronic disease management and more. HEDIS® allows consumers to distinguish between health plans based on comparative quality instead of just cost, and provides a base for physician incentive programs. The Centers for Medicare and Medicaid Services (CMS) also requires HEDIS® information from all Medicare Advantage plans, while the Affordable Care Act requires HEDIS data for the Marketplace and the health insurance exchange.

The HEDIS® measures our staff will gather consist of, but are not limited to, the following:

•• Blood pressure

•• Medication reconciliation within 30 days after a hospitalization

•• Colorectal cancer screening

•• Cervical cancer screening

•• Prenatal and postpartum care – new for the Marketplace

•• Advanced care planning

•• Functional status assessment

•• Body mass index (BMI)

•• Well Child visits – new for the Marketplace

•• Counseling for nutrition and physical activity for children – new for the Marketplace

To comply with HEDIS® documentation requirements, medical charts should contain evidence of the service, date the service was provided, and result, consultation, lab or imaging report.

Rest assured that the information provided to Blue Cross of Idaho will be safeguarded to maintain the confidentiality of the patient record. Members have authorized the release of medical information to us in their member contract statement of understanding. Patient information will only be used for reporting purposes.

Our goal is to make every effort to complete the HEDIS® audit with as little inconvenience to your office staff as possible. Wherever possible, offices will only receive one visit to collect information. If you have any questions about the audit, please contact Jennifer Rawles at (208) 286-3676.

Are you ready for ICD-10? Blue Cross of Idaho is getting ready for the implementation of ICD-10, which goes into effect October 1, and we’re encouraging all providers to be prepared, too.

We want to help ensure that your practice is not impacted by being unable to submit claims after this date. Please work with your software vendor to make sure that you are prepared for the change.

As new information becomes available, we will communicate it to you through provider alerts and posts in the “What’s New” section of our secure provider portal.

If you have further questions, please contact your provider relations representative (PAP100).

Reminder for Medicare-Medicaid Coordinated Plan ProvidersAs part of the True Blue Dual Special Needs plan expansion, the State of Idaho requires all contracting Medicare Advantage or Medicare-Medicaid Coordinated plan providers and/or their office managers to complete mandatory training assessments. These assessments are located on the bcidaho.com provider portal under with your secure logon.

Select” Mandatory Training Assessments” on the left side of the page then, select “Tutorials and Certifications” on the top left. Under the Community Partners track, you will see a red “REQ” for the three assessments: Fraud Waste and Abuse, Non-Discrimination and Cultural Competence.

This training must be completed by all staff members who provide a service for a dual special needs member. The assessment completion will be automatically tracked for those who have a user ID and password for the portal. If your office has a large number of staff members who do not have a logon, please arrange to conduct the training at a monthly department meeting so your entire staff can be trained in these areas. You can either print the slides from the portal, or log on and walk through the PDF images. This training is mandatory and must be completed.

Please contact your external provider relations representative if you have any questions (PAP100).

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Don’t Forget

St. Alphonsus Health Alliance Updates

Effective February 1, the St. Alphonsus Health Alliance will no longer require referrals for True Blue Connected Care as long as the patient is being seen by an in-network provider.

Please ensure that any provider you are referring a patient to is an Alliance provider, or has a contract with True Blue Connected Care. You can use both the Blue Cross of Idaho website, bcidaho.com, and the Alliance website to find an in-network provider. Please continue to coordinate care with the patient’s PCP to help us continue providing quality, cost-effective care.

If a patient requires treatment by an out-of-network provider, prior authorization must be obtained through Blue Cross of Idaho. Current True Blue authorization requirements must be met, and are available on the Blue

Cross of Idaho website.

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Please Update Your Provider Information SheetBlue Cross of Idaho adopted a new Provider Information Sheet in September 2014. The updated format and content lets us capture the information necessary to meet our regulatory requirements regarding provider configuration.

Unfortunately, some providers continue to use the outdated form.

When submitting provider information to Blue Cross of Idaho, please make sure you are using the Provider Information Sheet with Form No 9-105 (09-14) at the bottom of the form. This is the only Provider Information Sheet available on our provider portal. Please dispose of all copies of older forms.

Tribal Exchange PoliciesBlue Cross of Idaho is creating two new alpha prefixes for our tribal policies that make them easier to identify. We will notify you when the two new prefixes become effective. The two new alpha prefixes are:

• XMK for Tribal CCO/POS products

• XMY for the Tribal PPO product

Please note: If you are seeing a tribal member and you are not part of a Tribal Health Clinic, you will need to obtain a referral. If you do not get a referral, the member’s benefits may be impacted. The referral information from a Tribal Health provider must be entered in fields 17 and 17a on the CMS 1500 claim form or field 80 on the UB04 claim form. An individual physician’s name and NPI must be included on the claim form, not a group name and NPI.

Blue Cross of Idaho’s Truven

Reporting ToolBlue Cross of Idaho has a reporting tool designed to share information about comparative healthcare cost patterns in Idaho.

The adjusted cost scores generated by these reports will be used to determine the key performance indicator (KPI) on the physician fee schedule effective July 1. The adjusted cost scores will replace the current contact KPIs, which are generic prescribing and access to care requirements (single conversion factor contract only). The new reports compare practice patterns for commonly treated conditions among peers throughout the state practicing the same specialty.

The reports are based on commercial claims submitted to Blue Cross of Idaho and exclude Federal Employee Plan and Medicare Advantage claims. They are not intended as a statement as to the ability or quality of a physician, but strictly a means to relate the relative cost efficiency of each physician within his or her specialty.

The reports are based on cost and utilization for a 12-month period. An adjusted cost score of 1.00 reflects the peer group average. A score less than 1.00 indicates a clinic’s or physician’s costs for treating common conditions are lower than the average for their specialty. A score greater than 1.00 indicates a clinic’s or physician’s costs are higher than the average within their specialty.

The scores are adjusted for patient complexity to include elements such as the age, gender, comorbidities, and severity/complexity of the medical episode grouping. Each clinic’s score is available on the Blue Cross of Idaho website under a secure log in. The report reflecting the adjusted cost score for the clinic will be listed under the “Key Performance Indicator” section.

If you have any questions, or wish to schedule a meeting to discuss this information and review the details, please contact Becki Wallace, health systems performance specialist at 208-331-8874 or bwallace@bcidaho.com.

© 2015 by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association

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Medical Management Managed Health Care/Review, Preadmission/Admission Certification, or Individual Benefits Management and Case Management

n 208-331-7535 n 800-743-1871 n Voice mail available after office hours and on holidays and weekends

Medicare Medicaid Coordinated Plan True Blue® Dual Special Needs Plan Hours:

n 8 a.m. - 9 p.m., MT seven days a week n Member Line Dual Special Needs Plan: 888-495-2583

n Waiver Providers Support Line: 866-588-6174

Blue Cross of Idaho Help Desk

Electronic Billing Errors, Error and Acceptance Reports

n 8 a.m. – 5 p.m. MT (Monday – Friday), n 888-BCI-EDIA, 888-224-3341 or 208-331-8817

Provider Contact Center for Commercial and Medicare Advantage

Benefits, Coverage and Authorization

n 8 a.m. – 5 p.m. MT (Monday, Tuesday, Thursday, Friday) 8:30 a.m. – 5 p.m. MT (Wednesday)

n208-286-3656 or 866-482-2250

Post-service claim questions log onto our secure website at bcidaho.com and select Contact Us.

External Provider Relations – Questions regarding website applications such as electronic billing, eligibility, claims, authorizations, internet services or requests for FREE on-site training

n 866-283-5723 or 208-286-3602

Ext. 8309: Jamie Hunihan – City of Boise, St. Lukes Health Systems statewide. Counties: Boise, Canyon, Gem, Payette

Ext. 8307: Kathy Brock, CPC-P – Counties: Adams, Benewah, Bonner, Boundary, Clearwater, Idaho, Kootenai, Latah,

Lewis, Nez Perce, Shoshone, Valley and Washington

Ext. 8308: Diane Mortensen, CPC – Cities: Eagle, Garden City, Kuna, Meridian, Star. Counties: Blaine, Butte, Camas,

Cassia, Custer, Elmore, Gooding, Jerome, Lemhi, Lincoln, Minidoka, Owyhee and Twin Falls

Ext. 7032: Angie McCormick – Counties: Bannock, Bear Lake, Bingham, Bonneville, Caribou, Clark, Franklin, Fremont,

Jefferson, Madison, Oneida, Power and Teton

Any Questions?

2015 Idaho HealthCare Conference SAVE THE DATE!!!

Clarkston - May 5Quality Inn700 Port Drive

Idaho Falls - May 12Shilo Inn780 Lindsay Blvd.

Twin Falls - May 14Canyon Crest Event Center 330 Canyon Crest Drive

Coeur d’Alene – May 6Best Western CDA506 W. Appleway Avenue

Pocatello - May 13 Red Lion1555 Pocatello Creek Road

Boise - May 21Boise Hotel & Conference Center3300 S Vista Ave

Idah

o H

ealth Care ConferenceCoin of Excellence

Off to the Races!