Section 1: Reminders

Transcription

1 June 1, 2005 S The Blue Shield Report is published by the professional relations department of Blue Cross and Blue Shield of Kansas. OUR WEB ADDRESS: Cathy Holmes, RHIT, CPC Manager Internal Operations Dorothy Bahner Communications Coordinator Questions: Contact your professional relations representative, or the professional relations hotline in Topeka at or CPT is a trademark of the American Medical Association. Inside This Issue: Section 1: Reminders Accurate Provider Information Important pg. 1 New ID Numbers..pg. 2 Patient Dismissal for Premier Blue and Blue Select pg. 2 Unna Boot Proper Billing..pg. 3 Section 2: Updates Correct Place of Service for A4627..pg. 3 Dorsal Night Splints Proper Billing... pg. 3 Provider Offices Targeted for Identity Theft....pg. 3 Provider Satisfaction with BlueCard Claims Handling Increases. pg. 3 Right of Offset..pg. 4 Subsequent Hospital Care ( ) pg. 4 Section 3: Pharmaceuticals Prime Therapeutics Formulary Update.pg. 4 Section 1: Reminders Accurate Provider Information Important Blue Cross and Blue Shield of Kansas (BCBSKS) strives to maintain the accuracy of our provider file information. Our online provider directories are updated weekly and correct data assists our members when selecting providers. In addition, provider reimbursement is not delayed because of outdated addresses. Providers should notify us as soon as possible when changes to any of the following occur: Provider name Practice name Mailing address Telephone number Fax number Tax ID number Specialty Acknowledgement: Current Procedural Terminology (CPT) is copyright 2004 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use.

2 Blue Shield Report S June 1, 2005 Page 2 To assist providers in keeping their information up to date, a new option has been added to the secure section of where they can view how we have them set up in our provider files. In the near future, providers will be able to submit their National Provider Identifier (NPI) numbers through this option. Providers may also call the professional relations hotline at (Topeka) or to speak with their professional relations representative to update their records. In addition, a provider information change form is available on our Web site at: New ID Numbers In order to protect the privacy of our members, BCBSKS recently converted all IDs from Social Security Numbers to randomly selected numbers. As reported in Blue Shield Report S and S-09-04, the new ID numbers must be used beginning July 1, Member eligibility is available on the Secured Services section of our Web site. Patient Dismissal for Premier Blue and Blue Select To dismiss a Premier Blue or Blue Select member, the following steps apply: 1. At the same time your office is sending the dismissal letter to the member, a copy of the dismissal letter must be sent to: o Blue Cross Blue Shield of Kansas Attention CC 466E SW Topeka Blvd Topeka KS o Or faxed to Always include in your letter the Premier Blue / Blue Select ID number and the names of all members being dismissed. When we do not have this information, a contact to your office will be necessary to obtain the information. 3. If your office policy dictates a member dismissed from your practice cannot choose another physician in your group, indicate this in your letter. If this is not stated, we will allow the member to select another physician within your group if they request one. 4. When our office receives a dismissal letter more than 30 days past the date on the letter, we will be happy to process the dismissal upon receipt of an updated letter to the member. Upon receipt of member dismissal letters, our office immediately takes steps to notify the member of the need to select a new PCP. The effective date of the dismissal is the first of the month following 30 days of receipt of the dismissal letter from your office. More information on patient dismissals can be found on our Web site by clicking on Providers, Publications, Professional, Policy Memos and selecting one of the documents indicated below: Premier Blue Policy Memo or Professional Policies and Procedures, Section XVI Blue Cross Blue Shield of Kansas Policy Memo No. 4, Section VII

3 Blue Shield Report S June 1, 2005 Page 3 Unna Boot Proper Billing BCBSKS considers the Unna boot to be content of service of the evaluation and management procedure if billed together. It is, however, appropriate to bill for only the Unna boot (procedure code 29580) if that is the primary reason the patient is being seen. Section 2: Updates Correct Place of Service for A4627 When A4627 (Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler) is sent with the member for home use, it should be billed under place of service 12 (home). If A4627 is used in the office setting, it is content of the evaluation and management or office service. Dorsal Night Splints Proper Billing We have recently seen claims for one-piece dorsal night splints (DNS) coded incorrectly as L1930 (Ankle-foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment). In addition, the prepackaged DNS come with the inner lining, which has been submitted as code L2820 (Addition to lower extremity orthosis, soft interface for molded plastic, below knee section). These prepackaged splints do not meet the definition of the above codes because of the type of fabrication and design. Future charges for one-piece DNS and prepackaged lining should be lumped and coded as L2999 (Lower extremity orthoses, NOS). Please attach product information and use modifier 22 when submitting the claim. Provider Offices Targeted for Identity Theft BCBSKS has learned that providers are being targeted by scam artists who may represent themselves as payors to obtain social security numbers and other information providers normally share with legitimate payors. We recommend that providers establish an office protocol to authenticate whom is calling to request such information. We here at BCBSKS have protocols we follow to ensure that we do not give out information to persons not authorized to receive that information. Provider Satisfaction with BlueCard Claims Handling Increases As a Blue Cross and/or Blue Shield Plan, we are proud of our 76-year history of service in the healthcare industry. Because of our partnership with providers, like you, over 90 million members across the nation choose Blue Cross Blue Shield as their health insurer. That includes 619,366 members insured by BCBSKS and 165,399 members of other Blue Plans who reside in the BCBSKS plan area. To build on our successful history, we are focusing on your needs by simplifying administrative processes and improving our service to you. The Blue System holds focus groups, reviews satisfaction surveys, and collects feedback from our phone and field representatives who interact closely with providers. We ve used this research to deepen our customer focus, improve our service delivery with the BlueCard Program (out-of-area claims) and implement new technology to meet your changing needs.

4 Blue Shield Report S June 1, 2005 Page 4 BCBSKS is pleased to share the 2004 research results in which providers tell us that we are improving your satisfaction with the BlueCard Program. Providers note significant service delivery improvements in claims accuracy and resolution from 2003 to 2004: Claims accuracy improved 6% Satisfaction with resolving problem claims increased 8% Number of claims requiring follow-up decreased 10% BCBSKS is proud to be your single point of contact for Claims, Provider service, and Provider education related inquiries. In 2005, we are committed to further improve our service to you by: Continuing to improve claims accuracy and claim resolution Improving claims timeliness and Promoting internal education to ensure excellent provider service experience We want you to know that we re listening, we ve heard you, and we re constantly improving. This is our continuing commitment to you. If you have questions about the BlueCard program or filing claims for out-of-area patients, please contact your Professional Relations Representative or the Professional Hotline at , option 1 or , option 1. Right of Offset We previously communicated in the article Right of Offset in Blue Shield Report S that we would be implementing auto deduct for all providers once testing had been successfully completed. We have completed testing and will implement auto deduct July 1, The Remittance Advice will provide complete information on adjustments. For example, the patient s name, ID number, date of service, and claim-specific information will be displayed as a voided claim followed by the corrected processing of the adjusted claim. An example of a voided claim can be found on page 17 of Blue Shield Report S Many providers identify overpayments and return a check to balance their books. We will continue to receive and process these refunds. Subsequent Hospital Care Effective July 1, 2005, subsequent hospital care ( ) billed by physicians will be denied not medically necessary if the facility s inpatient days have been determined to be not medically necessary. Section 3: Pharmaceuticals Prime Therapeutics Formulary Update The April 2005 Prime Therapeutics formulary update is enclosed in this newsletter.

5 F O R M U L A R Y U P D A T E S A P R I L Blue Cross and Blue Shield of Kansas Select Formulary Additions Blue Cross and Blue Shield of Kansas Select Formulary Deletions GE NE RIC PRODUCTS ADDE D Brand-name products (in parentheses) are non-formulary and listed for reference only cilostazol tabs (PLETAL) clindamycin vaginal crm (CLEOCIN) gabapentin tabs, 100 mg, 300 mg, 400 mg (GABARONE) lidocaine lotn, 3% (LIDAMANTLE) lithium carbonate extended-release tabs, 300 mg (LITHOBID) methylprednisolone tabs dose pack, 4 mg (MEDROL DOSEPAK) prednisolone sodium phosphate oral soln, 15 mg/5 ml (ORAPRED) BR AND - NAME PRODUCTS REMOVED Generics remain CELEXA (citalopram oral soln) CLEOCIN (clindamycin vaginal crm) NEURONTIN tabs (gabapentin tabs) ORAPRED, 15 mg/5 ml (prednisolone sodium phosphate oral soln) PARAPLATIN (carboplatin inj & carboplatin for inj) PARLODEL, 2.5 mg (bromocriptine tabs) PLETAL (cilostazol tabs) WELLBUTRIN SR,200 mg (bupropion extended-release tabs) GE NE RIC PRODUCTS ADDE D Brand-name products (in parentheses) are also on formulary didanosine delayed-release caps (VIDEX EC) pilocarpine tabs, 5 mg (SALAGEN) BR AND - NAME PRODUCTS ADDED APOKYN (apomorphine inj) CIPRO (ciprofloxacin oral susp) CLOLAR (clofarabine inj) LEVAQUIN (levofloxacin oral soln) PARCOPA (carbidopa/levodopa orally disintegrating tabs) TARCEVA (erlotinib tabs) ALL VERSIONS, BR AND - NAME AND GE NERIC, IF AVAIL ABLE, REMOVED FROM FORMUL ARY carbinoxamine/pseudoephedrine, 2/15 per ml liq, 2/17.5 per 5 ml liq, 2/25 per ml soln, 2/15 per 5 ml syrup and 4/60 per 5 ml syrup flurazepam caps DISCONTINUED BR AND - NAME PRODUCTS The following discontinued brand-name product has been removed from the formulary STILPHOSTROL (diethylstilbestrol inj) DISCONTINUE D GE NE RIC PRODUCTS The following discontinued generic products have been removed from the formulary azelaic acid crm Finevin theophylline elixir theophylline oral soln