npi – the time is now! · npi – the time is now! as of may 23, 2008, we will all be required to...
TRANSCRIPT
Visit our Web site at www.bcbsil.com/provider
2007 HMO PCP Survey Results.... 2
2007 PPO Practitioner Survey Results .............. 3
Quality Site Visit Results........ 4
New! Legislative Corner.............. 5
NPI Corner........ 5
Workshop Schedule........... 6
Drug Safety ....... 6
Medical Records Process ............. 6
Drug Formulary Changes ........... 7
Fairness in Contracting ....... 7
What’sInside? NPI – The Time is NOW!
As of May 23, 2008, we will all be required to use only the NPI as the single provider identifier
in all HIPAA standard transactions, per the federal regulation. As providers make the
transition to NPI-only claim submission, it is important to keep in mind the following points:
Be aware that the BCBSIL provider number and/or state license number should no longer
be included on claims. As of May 23, 2008, claims including the BCBSIL provider number
and/or state license number in addition to the NPI will be rejected.
Providers who submit paper claims are requested to include taxonomy codes on claims,
along with the "ZZ" qualifier, where a qualifier is required. Please enter the taxonomy code
in fields where you formerly entered your BCBSIL provider number on paper claims. On
the UB-04 form, your taxonomy code may be entered in locator 57 as the Other Provider
Identifier. On the CMS-1500, use fields 17a, 24j, 32b, and 33b for the taxonomy code that
corresponds to the NPI entered in each related field. Entering these codes will help to
alleviate delayed claims processing.
Be sure to continue to use your Tax Identification Number (TIN) on all claims. Your
TIN is required for taxpayer reporting purposes; it will also enable BCBSIL to cross
reference your NPI to your existing provider record, if needed.
Contact your electronic trading partners (software vendor, billing service, and/or clearinghouse)
to ensure they have your NPI(s) and are equipped for NPI-only submission of your claims.
If you need assistance regarding how to transition to submitting NPI-only claims, contact
your Provider Network Consultant. If your vendor has any questions, they may contact our
E-Commerce Center at 1-800-746-4614.
Introducing BlueEdgeSM HMO –Delivering Innovation, Consumer Resources and Value
The HMOs of BCBSIL, through our
BlueAdvantageSM HMO and HMO
Illinois products, continue to deliver
value through cost-effective health
plans, network choices and customer
service our members can count on. By
combining the most effective features
of managed care with innovative plans
and consumer-directed resources, this
spring we are excited to introduce
BlueEdge HMO, one of the first HMO
consumer-directed health plans in
the marketplace.
Available with either the HMO
Illinois or BlueAdvantage HMO
network, BlueEdge HMO combines all
the standard HMO health care
benefits, including wellness visits and
preventive care, with a Health Care
Account. Employees can use this
spending account—funded by the
employer on a “pay-as-you-go” basis—
to help reduce their out-of-pocket
copayment expenses for services such
May 2008
continued on page 4
Visit our Web site at www.bcbsil.com/provider 2
Results are in from the 2007 HMO Illinois and BlueAdvantage HMO Primary Care Physician
(PCP) Survey. In all, BCBSIL received completed questionnaires from 802 HMO physicians.
The response rate was 18.5 percent. The table below highlights a comparison of results from
the 2006 and 2007 surveys.
The survey used a 5-point scale, from Excellent to Poor, to measure satisfaction. The results
shown below are based on combined responses in the top three boxes (Excellent, Very Good,
and Good). Results for the Hospital Information questions are based on the top two boxes
(Excellent and Very Good).
Hospital InformationNew to this survey were questions regarding the physician's tenure and likelihood to recommend
his/her primary admitting hospital. More than 83 percent of PCPs have been admitting to their
primary hospital for greater than five years. Ninety-five percent of PCPs would recommend their
primary admitting hospital to family and friends.
Continuity and Coordination between Managed Care Physicians and Health Care FacilitiesIn 2007, 83 percent or more of PCPs in the HMO were satisfied with the reports they received
from hospital inpatient facilities, outpatient surgery facilities, home health care agencies and
hospital emergency rooms, and with their feedback from general surgeons, cardiologists,
orthopedic surgeons, ophthalmologists, and dermatologists. PCP satisfaction with feedback
from behavioral health specialists remained unchanged at 73 percent for HMO PCPs.
Opportunities for ImprovementFeedback from behavioral health specialists is seen as an opportunity for improvement, as are
hospital related indicators.
2007 HMO Primary Care Physician Survey Results
New or revised Medical Policies will be posted in the
“Pending Policies” section of the Medical Policy site
on the BCBSIL Web site. The new or revised policies
will be available on the first day of each month. The
specific effective or implementation date will be
noted for each policy that is posted.
To review these policies, visit our Web site at
www.bcbsil.com/provider and select “Medical
Policies.” After reading the Medical Policies
Disclaimer, click on “I Agree.” The policies that are
awaiting implementation can be found in the
“Pending Policies” section of the Medical Policy site.
Medical Pol icy Disclosure Statement
View Managed Care Updates Onl ineHMO and BlueChoice Updated Policies and Procedures on WebOn a monthly basis, we post updated policies and procedures on our Web site under “Updates.” Go towww.bcbsil.com/provider to view the updated policies.
HMO and BlueChoice Appointment/Reappointment Report on WebOn a monthly basis, we post a report of the Appointedand Reappointed providers on our Web site. To access this report, go to www.bcbsil.com/provider.Select “Appointed/Reappointed PCPs/PSPs” under the Credentialing/Contracting section. The cumulative data is updated by the third Wednesday of each month.
BlueChoice Updated Depart List A listing of all specialists no longer participating inthe network for the BlueChoice product can be foundat www.bcbsil.com/provider/securedpage.htm.
Note: You can find participating specialists for the BlueChoice product on our Provider Finder®
at www.bcbsil.com.
HMO Survey Questions HMO PCPs2007 2006
Survey Response Rate 19% 19%Overall Satisfaction * 90% 87%Referral Process *
· Overall Process 85% 84%· Adequacy of Specialist Network 85% 84%· Quality of Specialist Network 91% 90%
Utilization Management *· Case Management 87% 86%· Timeliness 85% 85%· Overall UM Process 86% 86%
Claims Payment *· Timeliness 80% 80%· Accuracy 82% 80%
BCBSIL Services· Provider Telecommunications Center (PTC) Overall 75% 76%· Have accessed Web site/internet tools for communications ^ 41% NA
o NDAS Online/Ecare ^ 92% NAo iExchange ^ 88% NA
After-Hours Access· Response Time <30 minutes 93% † 90%
Hospital Information (Top Two Box scores)· Pharmacy, in terms of providing medication correctly 75% 76%· Adequacy of the number of nurses 59% 57%· Accuracy of processing physician orders 70% † 66%· Quality of discharge plans 69% 66%
· Agree that ER reports for patients not admitted to hospital arereceived in timely manner before follow-up care
72% † 68%
* HMO physicians were asked to evaluate the IPA on these attributes. ^ Baseline data in 2007. † Statistically significant change.
3 May 2008
Results are in from the 2007 PPO Practitioner Survey. Primary Physician specialties represented
were: Internal Medicine, Pediatrics, Obstetrics-Gynecology and General Practice. Consulting
specialties represented included, but were not limited to: Allergy, Cardiology, Dermatology,
Gastroenterology, General Surgery, Neurology, Ophthalmology, Otolaryngology, Orthopedics,
Psychiatry and Urology. BCBSIL Quality Improvement received 2,069 completed questionnaires, for
a 9.3 percent response rate. The table shows the results of the 2006 and 2007 surveys. Coordination
of Care results regarding feedback received from various facilities and key specialists are included.
The survey used a 5-point scale, from Excellent to Poor to measure satisfaction. The results
shown below are based on combined responses in the top three boxes (Excellent, Very Good,
and Good) or Yes answers. Hospital Information questions are based on the top two boxes
(Excellent and Very Good).
Hospital InformationNew to this year's survey are questions regarding the practitioner’s tenure and likelihood to
recommend his/her primary admitting hospital. More than 82 percent of PPO practitioners
have been admitting to their primary hospital for greater than 5 years. Ninety-seven percent
of practitioners would recommend their primary admitting hospital to family and friends.
Continuity and Coordination between Managed Care Physicians and Health CareFacilities and PractitionersIn 2007, more than 84 percent of PPO practitioners reported they were satisfied with reports
from health care facilities, including inpatient hospitals, outpatient surgery centers, skilled nursing
facilities, home health care agencies and emergency rooms. More than 89 percent were satisfied
with feedback from general surgeons, cardiologists, orthopedic surgeons, ophthalmologists and
dermatologists; and 82 percent were satisfied with feedback from behavioral health specialists.
Opportunities for ImprovementQuestions with Top Three Box satisfaction rates of 70 percent or less, and with Top Two Box
satisfaction rates of 80 percent or less, were seen as areas that may represent potential
opportunities for improvement.
2007 PPO Practitioner Survey Results
PPO Survey Questions 2007 2006Survey Response Rate 9% † 11%Overall Satisfaction 92% † 94%Utilization Management
· Precertifying Inpatient Admissions 83% † 87%· Authorizing Additional Days 83% 85%
PPO Network· Adequacy of Specialist Network 95% 95%· Quality of Specialist Network 95% 96%
Claims Payment· Timeliness 90% 91%· Accuracy 86% 88%
BCBSIL Services· Provider Telecommunications Center (PTC) Overall 67% † 74%· Have accessed Web site/internet tools for communications ^ 32% NA
o NDAS Online/Ecare ^ 81% NAo iExchange ^ 78% NA
After-Hours Access· Response Time <30 minutes ** 88% 90%
Hospital Information (Top Two Box scores)· Pharmacy, in terms of providing medication correctly 77% 79%· Adequacy of the number of nurses 57% 56%· Accuracy of processing physician orders 70% 70%· Quality of discharge plans 69% 69%
· Agree that ER reports for patients not admitted to hospital are received in timely manner before follow-up care
69% 67%
** Responses of PPO Practitioners in General Practice, Internal Medicine, Obstetrics-Gynecology, and Pediatrics only. ^ Baseline data in 2007. † Statistically significant change.
as outpatient surgery, inpatient hospital
stays, emergency room visits and
prescriptions.
BlueEdge HMO encourages our members
to accept greater accountability for their
health care spending. The resources
available to HMO members can help them
become more informed health care
consumers, working with their primary care
physician to make decisions that may lead
to improved health outcomes.
Consumer Tools Focus on Wellness To help members plan their health care
visits, practice a healthy lifestyle and
manage health conditions, we provide a
variety of resources for BlueEdge HMO
members. Staying Healthy, our preventive
care guidelines for members of all ages,
is updated and distributed annually to
members. Blue Access® for Members,
our secure online service at www.bcbsil.com,
provides tools and resources to help
members manage their health care and
benefits.
Members can use the online Personal
Health Manager to complete a Health Risk
Assessment, create a fitness program, plan
healthy meals and track their progress
toward meeting wellness goals. They can
research medical tests and health
conditions, and even e-mail questions to
nurses, dietitians, fitness trainers and life
coaches. To help motivate members to
adopt or maintain healthy behaviors, they
automatically earn Blue PointsSM for using
many of the Personal Health Manager
features. Points can be redeemed for health
and fitness products, gift cards and other
popular merchandise.
A Commitment to Members’ HealthWhile consumer resources let members
access wellness tools on a “self-serve” basis,
the HMOs’ Quality Improvement (QI)
Program actively reaches out to targeted
members. Projects focus on the preventive
care services and prevalent chronic
conditions that offer the greatest
opportunity to improve member health,
manage health care utilization and
control costs.
The QI Program combines performance-
based rewards for IPAs meeting national
treatment standards in caring for members
who have chronic conditions, such as
diabetes, asthma or heart disease, with
physician and member education. We
provide members with targeted chronic
conditions with information and tools to
help manage their care. To remind
members to get flu shots, mammograms
and Pap tests, and have their children’s
immunizations completed, we send age and
gender-appropriate preventive care mailers.
By monitoring the outcome of QI projects
on members’ health, we can demonstrate
the positive health impact of our efforts.
Customer Service Remains a PriorityTo make the HMO experience easy for
members, we make welcome calls to new
members to introduce them to their
benefits and member services. When
members want to change IPAs, order
replacement ID cards or take care of
other routine concerns, convenient
online tools or automated telephone
functions are available.
Our Customer Advocates have the training
and technology to help resolve other
concerns as quickly as possible – usually in
one phone call – when members have more
complicated questions or prefer to talk to
someone.
To learn about members’ experiences with
the HMOs, and to improve services, we
regularly survey members and solicit
feedback from the following groups:
• HMO Consumer Advisory Board
• Medical Director Roundtable
• Medical Groups Advisory Committee
Visit our Web site at www.bcbsil.com/provider 4
Introducing BlueEdgeSM HMO –Delivering Innovation, Consumer Resources and Value continued from page 1
Quality Site Visit Results
During 2007, Quality Site Visits were performed
for Primary Care Physicians in the HMO Illinois,
BlueAdvantage HMO, and BlueChoice contracting
provider networks. The site visit network results for
2007 have been compiled. The HMOs of BCBSIL
and BlueChoice are happy to report continued
improvement in Accessibility, Site Review of
Physician offices, Quality of Patient Care
Documentation, and Medical Record Quality for
2007. There was also a demonstrated improvement
in cholesterol testing and colorectal cancer
screening. Please review the Quality Site Visit
standards and Site Visit Comparisons on our Web
site at
www.bcbsil.com/provider/credentialing/sitevisits.htm.
The 2007 Site visit results demonstrate the following
network opportunities for improvement:
Quality of Patient Care:Documentation of:
• Coordination of care with the Primary Care
Physician for behavioral health practitioners
• Family medical history
• Illicit drug use
• Alcohol use
• Adolescent smoking history
• Adolescent smoking cessation advice
• Adult smoking cessation advice
Preventive:• Colon cancer screening – male and female age 50
and over
• Influenza vaccination – male and female for
diabetics, asthmatics and cardiovascular disease,
age 65 and over
In order to improve site visit results in 2008, the
HMOs and BlueChoice are requesting review and
discussion of these results. You can help us with our
site visit scheduling by doing the following:
• If you need to cancel a site visit, please let us know
five business days prior to the visit.
• If you use electronic medical records, please inform
us when we schedule your site visit.
Thank you for continuing to assist us in our Quality
Improvement efforts.
5 May 2008
New! Legislative Corner NPI Corner…
As debate continues over improvements to our current health care system both at the state
and federal level, we want to reiterate that BCBSIL is committed to promoting accessible,
cost-effective, quality health care. Our primary focus will always be to support proposals that
are in the best interests of our members, making sure they continue to receive the care they
need and the peace of mind they deserve. All of our efforts must enhance the quality and
affordability of care, while building a dependable, member-responsive health care system that
makes the one we have even better.
To firmly position ourselves in this discussion at the state level, BCBSIL has created a Legislative
and Policy Management area that will monitor trends and shifts in health care policy—
especially those that directly affect our membership base and provider network—as well as
track, analyze communicate and implement state legislation impacting our business model.
There are a number of health care related bills that have been introduced in the Illinois
General Assembly that will significantly affect the health insurance industry if they are
passed. Our Legislative and Policy Management area will provide information on
important health care related bills through this Legislative Corner column, which will appear
periodically in the Blue Review. This column will keep you updated on proposed bills, and
ultimately, bills that become law and their effective dates.
The following is a list of select 2008 Illinois health care related bills that have been introduced
in the General Assembly that we are currently tracking. You can find the full text and the
status of these bills at www.ilga.gov.
Bill Number Bill Title Bill Description
HB1432 Mandate: EatingDisorder Treatment
Changes definition of "serious mental illness" to includeeating disorders, including anorexia nervosa, bulimianervosa, and Eating Disorders Not Otherwise Specified(EDNOS)
HB4602 Mandate: ShinglesVaccination
Requires coverage for shingles vaccine approved formarketing by FDA, if vaccine is ordered by physicianslicensed to practice medicine in all its branches andenrollee is 60 years of age or older
HB4620 Mandate: Women'sCardiovascularPreventive DiagnosticTesting
Requires coverage for diagnostic testing for CV disease for women if diagnostic testing is ordered byphysicians licensed to practice medicine in all itsbranches, based on guidelines for preventive CV services issued by a nationally recognized medicalsociety or federal government agency.
HB4824 Mandate: CochlearImplants and Post-Implant Services forChildren within OneYear of Birth
Requires coverage for operations to implant cochlearimplants and post-treatment services for children identified within one year of birth as being deaf orhearing impaired.
HB4940 Wellness Coverage Provides that coverage for hospital/medical treatmenton an expense incurred basis may offer a reasonablydesigned program for wellness coverage that allows areduction in premiums or other expenses (rather thanincluding a reward or a health spending account contribution). Provides that individuals unable to participate in wellness program standards, due to anadverse health factor, shall not be penalized basedupon their adverse health status.
HB5285 Dependent Coverage -Sick Students
Requires continuation of coverage for dependent college students who take a medical leave of absenceor reduce his/her course load to part-time statusbecause of illness or injury.
How will my Payments Look in an NPI-only Environment?As of May 23, 2008, your 835 ERA and/or
supporting payment documents (PCS/EPS), will
include only your NPI. Please be aware that your
payment information will no longer include your
BCBS provider number once compliance is enforced.
Using Your NPI to Access the IVR as of May 23, 2008The Interactive Voice Response (IVR) system will
recognize any NPI that is on file with BCBSIL,
however, using your billing NPI will expedite your
transaction. In the event that your NPI is not on file
with BCBSIL, you may be prompted for additional
information, such as your Tax Identification
Number (TIN). If you are an HMO site or clinic,
you may use your site number to access the IVR.
If your NPI or TIN is unrecognized or invalid, you
will have partial or no access to member eligibility,
benefits or claims status via the IVR system. Instead,
you will be routed to a limited menu that includes
instructions on how to obtain an NPI.
You may access the IVR by calling 1-800-972-8088.
Hours of availability are: Monday through Friday,
6:00 a.m. – 11:30 p.m. (Central), and Saturday, 6:00
a.m. – 3:00 p.m. (Central). Please visit our Provider
Web site for a quick reference guide about IVR if
you need additional information.
Remember: Our special NPI Times bulletin, sent to
you on a monthly basis, is also archived in the NPI
section of our Provider Web site. Please continue to
rely on this archive and our Provider Web site for
the most up-to-date information, even following
May 23, 2008.
Visit our Web site at www.bcbsil.com/provider 6
Drug Safety Featured on our New Wellness Web Site Be Smart. Be Well.TM
Last summer we introduced you to the Wellness Web site, Be Smart. Be Well. – a new Web site
designed to raise awareness of prevalent, yet largely preventable health and safety issues.
Through interviews with medical professionals and video documentaries with individuals
whose lives have been changed, Be Smart. Be Well. seeks to engage and motivate people to
make smart and healthy choices.
The latest topic on Be Smart. Be Well. is drug safety, which features personal video
documentaries and explores how drugs affect mental health, drug addictions, abuse of OTC
medicines and more. Almost four billion prescription drugs are dispensed every year, and
many Americans take five or more drugs a day – increasing the chance for mistakes, negative
drug interactions, and even abuse.
Be Smart. Be Well. is periodically updated with new featured topics, and prior topics are
archived through the Additional Topics section. Be on the lookout for the next topic, Mental
Health, which will launch this summer.
We urge you to visit www.besmartbewell.com today, and invite you to share the site with your
patients, peers and employees.
Based on feedback from providers like you, we have made improvements to the medical
records process one of our top priorities. We now believe we have a much more efficient
process allowing us to send and receive medical records electronically among all Blue Cross
and/or Blue Shield Plans around the country. This new method significantly reduces the time
it takes to transmit supporting documentation for our out-of-area claims and eliminates lost
or misrouted records. BCBSIL has embraced this new technology, and we are excited about
related process improvements we expect to realize over the coming months. We also hope
your office notices improvements in the efficiency of these processes.
Please continue to submit your medical records to BCBSIL only when requested.
If you receive requests for medical records from other Blue Plans prior to rendering services,
as part of the pre-authorization process, please submit them directly to the member’s Plan
that requested them.
If you need any additional information about out-of-area claims (BlueCard Program) or have
suggestions for improvement:
• Talk to your Provider Network Consultant
• Visit us online at www.bcbsil.com/provider/bluecard_program.htm
• Leave a message for our PTC Provider Education Specialists at 1-618-998-2716
As always, we appreciate your feedback.
Improvements to the Medical Records Process for Out-of-Area Claims
You’re Invited!Regis ter onl ine for our provider workshops
The Provider Affairs Education Team at BCBSIL
offers a variety of complimentary workshops to help
keep you informed.
Here is a partial listing of workshop highlights:
• Consumer Driven Health Plan (CDHP)
• e-Solutions enhancements
• Web site tutorial information
• Provider Review/Appeals
• BlueCard® process improvements
• National Provider Identifier (NPI)
Visit our Web site at
www.bcbsil.com/provider/training.htm to view the
agenda and location, and to register for any
workshops you are interested in attending.
Upcoming Workshop Schedule:
Workshop: Ancillary Workshop - DME
Date: May 15, 2008
Location: Apria Health Care, Schaumburg, Illinois
Workshop: Ancillary Workshop - DME
Date: June 4, 2008
Location: Memorial Hospital, Springfield, Illinois
Workshop: Ancillary Workshop - CHC/HIT/Hospice
Date: June 10, 2008
Location: Apria Health Care, Schaumburg, Illinois
Workshop: eSolutions
Date: June 11, 2008
Location: Holy Family Medical Center,
Des Plaines, Illinois
Workshop: New PPO Provider Workshop
Date: June 12, 2008
Location: Little Company of Mary,
Evergreen Park, Illinois
Workshop: Blue News You Can Use
Date: July 9, 2008
Location: OSF St. Joseph Medical Center,
Bloomington, Illinois
Workshop: Ancillary Workshop - CHC/HIT/Hospice
Date: July 23, 2008
Location: Memorial Hospital, Springfield, Illinois
Workshop: Ancillary Workshop - SNF
Date: August 7, 2008
Location: Memorial Hospital, Springfield, Illinois
7 May 2008
Formulary Changes
In addition, the respiratory device products listed in the table below will change to
non-formulary status on July 1, 2008. The Breatherite aerosol holding chamber will be the
only product on the formulary; it may be used with most inhalers available by prescription.
New Generics Expected to Launch in 2008Generic equivalents are expected to launch in 2008 for the medications listed in the following
table. More details regarding the launch dates will be provided as they become available.
Photo Documentation Update
It is no longer necessary to send photo documentation
to us for the review or adjudication of health care
claims if t is not:
• required per the medical policy, or
• requested by BCBSIL
We have detected discrepancies when providers
complete Box 15 of the CMS-1500 claim form (08/05
version). Box 15 requests the first date of medical advice,
diagnosis, care or treatment given by a licensed
health care professional for patients with a pre-existing
waiting period clause effective on their policy. This date
is determined by the patient's health history information,
and not the date the patient was first seen for thisdiagnosis by your office for that episode.
NOTE: Wal-Mart and ITW Groups will still require
medical records to determine the first date of treatment.
If you have any questions, please contact our
Provider Telecommunications Center at
1-800-972-8088, or leave a message for their
Provider Education Specialists at 1-618-998-2716.
Pre-Existing Waiting Period
Fairness in Contracting
New Account Group
Non-Formulary Brand*(Tier 3
copayment/coinsurance)
Generic Alternatives(Tier 1
copayment/coinsurance)
Formulary Brand Alternative*(Tier 2
copayment/coinsurance)
Metadate CDdextroamphetamine extended
release, methylphenidate extended release
Concerta
Soltamox solution tamoxifen tablets
Vivelle/Vivelle DOT patches estradiol patches Estraderm patch
*Third party brand names are the property of their respective owners.
Non-Formulary Respiratory DeviceProducts*
(Tier 3 copayment/coinsurance)
Formulary Respiratory Device Products*(Tier 2 copayment/coinsurance)
ACE Aerosol Cloud Enhancer Breatherite
Aerochamber
Easivent
E-Z Spacer
Inspirease
Microchamber
Microspacer
Optichamber, Zoey Optichamber
Optihaler
Pocket Chamber
Pocket Spacer
Vortex
*Third party brand names are the property of their respective owners.
Medication Common Disease State/Condition Expected Launch Date
Cosopt/Trusopt Glaucoma Oct-08
Depakote Seizures Sep-08
DynaCirc CR High blood pressure Jul-08
Imitrex Migraine Oct-08
Lamictal Seizures Jul-08
Requip Parkinson’s Disease May-08
Sonata Insomnia Jun-08
Group Name: IPSCO, Inc.Group Number: 021492Alpha Prefix: PSCProduct Type: PPO(Portable)Effective Date: Apr. 1, 2008BC BS
In an effort to comply with Fairness In Contracting
Legislation and keep our contracting providers
informed, BCBSIL has designated a column in the Blue
Review to notify you of any changes to the physician
fee schedules. Be sure to review this area each month.
Effective April 1, 2008, codes A9552, J7611, J7612,
J7613 and J7614 were updated.
Effective April 15, 2008, code 90681 was updated.
Codes E0471 and E0472 have been removed from the
BCBSIL DME life sustaining list effective in 2008.
Providers can request fees by downloading the Fee
Schedule Request Form at
www.bcbsil.com/provider/forms.htm.
Effective July 1, 2008, some revisions will be made to the BCBSIL formulary. These revisions
are based on the availability of new prescription medications and our National Pharmacy and
Therapeutics Committee’s review of changes in the pharmaceutical market.
The formulary status of Metadate CD, Soltamox, and Vivelle/Vivelle Dot will change to non-
formulary brand. Generic and formulary brand alternatives are listed in the table below.
Brand Name Medications Moved to Third-tier Payment Level
We want to hear from you! Let us know if the Blue Review continues to meet your standards.
Does this publication address your needs?What topics would you like to read about?
BCBSIL’s success is dependent on your business as acontracting provider. The Blue Review has been created
to communicate tools,updates and tips to support your health care practice. Think ofthe Blue Review as acanvas for your BlueCross and Blue Shieldbusiness information.
We invite you to submit your feedback
and suggestions for improvements via e-mail, to [email protected].
Blue Review is a monthly newsletter published for Institutional and ProfessionalProviders contracting with Blue Cross andBlue Shield of Illinois. We encourage you toshare the content of this newsletter with yourstaff. The Blue Review is located on our Website at www.bcbsil.com/provider.
The editors and staff of the Blue Reviewwelcome letters to the editor. Address letters to:
Blue ReviewBlue Cross and Blue Shield of Illinois300 E. Randolph Street – 25th FloorChicago, Illinois 60601-5099Email: [email protected]
(312) 653-4019, or fax (312) 938-8021Web site: www.bcbsil.com/provider.
Publisher: Phil Lumpkin, VP, Provider AffairsEditor: Carol Pjosek, DirectorManaging Editor: Jeanne Trumbo, Sr. ManagerEditorial Staff: Margaret O’Toole, Marsha Tallerico and Allene Walker.
Visit us online at www.bcbsil.com/provider
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