One to One Newsletter

Transcription

1 One to One Newsletter DENTAL SUMMER EDITION Blue Cross of Idaho has been busy since the beginning of the year. Much of the information this quarter is important for appropriate coding, getting good information on the online employer portal, enhancing patient wellness screenings and managing gaps in care. The information is in categories based on whether the article is Informational (for education only), Action (requires action on your part) or Reminders (notification/reminder of events or deadlines to come). Topics in this edition of the Provider Newsletter include: Informational Provider Relations Business Model Changes Claim Status Application Upgrade New Faces Actions Medical Drug Prior Authorization Changes Prior Authorization Procedure Code Look-Up Phase 2 Fraud, Waste and Abuse Reminders Provider Reminders and Updates

2 Informational Provider Relations Business Model Changes Blue Cross of Idaho provider relations department updated our business model to better align with the needs of our provider community. On July 2, 2018, we eliminated designated representatives for each region of the state. When you contact Blue Cross of Idaho now, there are two dedicated relations representatives answering your calls and four dedicated relations representatives responding to your s for contracting, credentialing, website and other escalated questions. In addition, our phone menu will change. You will have four options: Customer Risk Service Engagement Provider All Other Appeals (Provider Relations) Current phone numbers are not changing. You can still reach us at the following numbers. Local: Toll free: Medicare/Medicaid: Medicare/Medicaid toll free: However, the address has changed. Now submit questions via to the following address: Post Service claim questions will continue to be submitted through current process via our secure provider portal. Please refer to DPAP 100 for this updated contact information. 2 BLUE CROSS OF IDAHO DENTAL NEWSLETTER

3 Claims Status Application Upgrade On April 27, Blue Cross of Idaho released an updated Claims Status search tool. The tool has a new look and functionality that makes it easier to use. The tool displays all claims processed by Blue Cross of Idaho including commercial, Medicare Advantage and the Federal Employee Program (FEP). The Claims Status search tool is available to providers who register on our secure provider website at providers.bcidaho.com. Select Eligibility & Claims Select Claims Status Here are some of the updates: Displays FEP claim information s FEP claim questions directly from the claim Matches dental detail to the remittance advice Displays dental tooth numbers Provides individual patient remittances for submission to secondary insurance, if required Displays claims in process when medical records are requested requested and requester info for in process claims Searches by provider more efficiently Searches by entity (clinic/facility) or claim number Sorts claim results by additional functions Hyperlinks to the remittance advice and electronic funds transfer (EFT) tools on the claims detail page Please note soon our automated phone system will also include FEP claim information. Training on this new functionality is available monthly. Registration is not required. To attend, please have your Blue Cross of Idaho username and password available. Log on to providers.bcidaho.com Under Important Announcements, select Webinar Schedule Review the details for the session tailored to your practice type and the date and time that fits your schedule Displays what medical records were SUMMER

4 New Faces Provider Network Management Chris Murphy Provider Network Manager Chip Sitton Provider Network Manager Provider Contracting Ancillary Contracting Brandy Coulombe Provider Contract Specialist Debbi Lowe Provider Contract Specialist Kristi De La Cruz Provider Contract Specialist Shannon Ortgiesen Provider Contract Specialist Provider Information Management Jeanette Ostman Provider Information Management Specialist Lauren Loya-Martinez Provider Information Management Specialist Provider Analytics Joe Sheire Business Analyst Ellen Eldridge Health Data Analyst Provider Relations Lorinda Summers Provider Relations Representative 4 BLUE CROSS OF IDAHO DENTAL NEWSLETTER

5 Action Medical Drug Prior Authorization Changes Blue Cross of Idaho is implementing a new process for getting prior authorization. We have delayed the implementation of this program to ensure the process works correctly. The new effective date is planned for August 17, 2018, you will use the CVS Caremark powered by NovoLogix Online Prior Authorization system to request prior authorizations for certain medications. You can access the authorization system through your login on the Blue Cross of Idaho secure provider website. Please refer to the list for the medicines that are part of the Prior Authorization program. A list of medications requiring prior authorization is available by logging on to our secure provider portal at providers.bcidaho.com. 1. Select Forms & Resources 2. Select Pharmacy 3. Select Prior authorizations & step therapy The CVS Caremark powered by NovoLogix Online Prior Authorization system provides a streamlined process for your medicines through online prior authorization management services, including: Efficient intake process through the utilization of an online authorization system Real-time status updates Blue Cross of Idaho is offering online training through WebEx as well as an on-demand training video and instructional guide. The sessions provide information on how to request prior authorization and review the status of authorized services. Questions about prior authorization? Call the CVS Case Review Unit toll-free at from 6:30 a.m. - 8 p.m. CT, Monday - Friday. We look forward to working with you to coordinate the best care for your patients. SUMMER

6 Prior Authorization Procedure Code Look-Up Phase 2 We have launched a new application, Prior Authorization Procedure Code Look-Up that allows providers to enter medical procedure codes at the member level to determine if authorization is required. This includes medical drug, some dental, DME and medical codes. This application was effective for dates of service August 28th, 2017 forward. It does exclude Federal Employee Program (FEP) and Medicare Medicaid Coordinated Plan (MMCP) members. Please read through the instructions and disclaimer before use. Phase 2 will include the following functionality: When searching for the enrollee, after you select Search, the member s enrollment status will appear under their name with the word active or inactive. When entering the procedure code, it will give you a hyperlink to the correct application to complete your authorization. This application is available on the secure provider portal at providers.bcidaho.com in multiple locations: Select Authorization & Notifications, then Prior Authorization Procedure Code Look-Up or Select Forms & Resources, Medical Management then Utilization Review or Select Tools & Reports, Tools then Prior Authorization Procedure Code Look-Up 6 BLUE CROSS OF IDAHO DENTAL NEWSLETTER

7 Fraud Waste and Abuse Blue Cross of Idaho contracts with you to provide medically necessary, cost-effective, quality care to our members. You exert significant influence over what services your patients receive. You control the documentation describing what services they actually received, and your documentation serves as the basis for claims sent to us for services provided. While the vast majority of hard-working providers are ethical, a minority of unscrupulous providers unnecessarily raise the cost of healthcare for all. In doing your part to prevent fraud, waste and abuse, here are a few things to watch for and avoid. Common types of healthcare fraud: Phantom Billing Adding otherwise legitimate charges for services never performed or fabricating claims Upcoding Charging for a more expensive service such as a high-level office visit but actually providing a short, low-level office visit Providing unnecessary care Including unnecessary tests, surgeries and other procedures Misrepresenting services Performing uncovered services but billing for different services that are covered Unbundling Charging separately for procedures or tests that are actually part of a single procedure Masquerading as healthcare professionals Delivering healthcare services without proper licenses Doctor Shopping Bouncing from one doctor to another to obtain multiple prescriptions for controlled substances Identity Theft Using another person s health insurance card or identification to obtain healthcare or other services or impersonating that individual Enrollment Fraud Knowingly misrepresenting health status or dependent status, or purposely failing to report a divorce or marriage of a dependent We encourage anyone who suspects possible fraudulent activity to report it to us -- you have the option to remain anonymous. Call the fraud hotline at , or fraudreporting@bcidaho.com. SUMMER

8 Reminders Provider Reminders and Updates Please remember when sending in a provider enrollment packet that your packet is complete when you have included the entire packet and forms outlined in the Provider Enrollment link found on the Blue Cross of Idaho website. Any packet missing forms or requested documents will be returned with a checklist of missing items and will require you to resubmit. You will find the provider enrollment packet under the tab Forms & Resources in the Provider Portal. When checking the status of your provider s enrollment packet, please allow 30 days from submission before calling or ing. You can check the status of your provider s credentialing status under the tab Tools & Reports in the provider portal of the website. Effective July 1, 2018, provider contract effective dates will be 30 days from receipt of a complete packet and signed contract. Please keep this in mind when you have any tax ID updates or new provider contract requests. 8 BLUE CROSS OF IDAHO DENTAL NEWSLETTER

9 Any Questions? BLUE CROSS OF IDAHO HELP DESK Electronic Billing Errors, Error and Acceptance Reports: PROVIDER CONTACT CENTER Benefits, Coverage and Authorization: 7 a.m. 7 p.m. MT, Monday Friday, EXCEPT closed 2-3 p.m. MT, Thursday or For post-service claim questions, log onto our secure website at providers.bcidaho.com and select Contact Us. PROVIDER RELATIONS Questions regarding coding, contracting or need website training: or PRproviderrelations@bcidaho.com