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Provider Resource Guide

QUALITY

COMMERCIAL 2020

Table of ContentsQuality Resources for You and Your Patients . . . . . . . . . . . . . . . . . . . 1

Resources for Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Educating Our Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Provider Resources

Keeping You Up-to-Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Availity® Provider Portal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Assistance with Supplemental Data Collection . . . . . . . . . . . . . . . . 4

CAHPS Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Member Resources

Health Education Resources Available to Members . . . . . . . . . . . . 7

Outreach Campaigns to Targeted Members . . . . . . . . . . . . . . . . . . 8

On-Site Health Screening Events . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Member Wellness Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Our Focus on Medication Adherence . . . . . . . . . . . . . . . . . . . . . . 11

Assistance in Closing Quality Measures . . . . . . . . . . . . . . . . . . . . 12

Individualized Member Health Planners . . . . . . . . . . . . . . . . . . . . . 13

Focus for 2020 Health Planners . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Sample Health Planner with Health Indicators and Tips . . . . . . . . . 15

Your Commercial Quality Improvement Team . . . . . . . . . . . . . . . . 16

Provider Resource Guide 1

We Value Your Participation in our Quality ProgramWe know you’re already providing high-quality care for your patients, and we want to ensure your practice gets the recognition it deserves . You’re helping our members get important preventive screenings, providing effective, timely treatment, and improving medication adherence so they can be as healthy as possible . This quality care is central to our mission of delivering peace of mind through better health to the members we serve .

Quality Resources for You and Your Patients

Resources for ProvidersTo keep you informed of changes and best practices, we provide monthly, quarterly and annual publications . We also offer a range of services and events, as well as onsite visits, to support your success in closing HEDIS® measures for your patients .

Educating Our MembersWe believe quality care involves the promotion of care management for health and wellness measures as they relate to members’ chronic conditions, age, gender and behavioral health . Our goal is to empower the member to focus on preventive care and chronic condition management so they can make informed decisions, and have an active voice in their health care .

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)


Monthly BlueAlert Provider NewsletterThe BlueAlert newsletter gives you timely information on forms and process changes, coding tips, drug coverage and more . The current edition and archives are located on bcbst.com/providers .

Keeping You Up-to-Date

Quality Care Quarterly NewsletterEach quarter, we send providers who participate in our quality programs a link to the quality newsletter . In it you’ll find a variety of informative articles including best-practice highlights from your peers, helpful information on important HEDIS measures, tips on using the QCR tool, and upcoming events and training opportunities .

The current edition of the Quality Care Quarterly is at provider.bcbst.com, under Quality Care Initiatives . Previous editions are in the archived newsletters at Provider News and Updates .

BlueAlertSM

MARCH 2019

BlueCross BlueShield of Tennessee, Inc.This information applies to all lines of business unless stated otherwise.

Use Availity® to Get the Answers You Need Through Availity, you can get the answers you need 24 hours a day, seven days a week. Not only can you transact with us online, you have access to other payers, too – all through one convenient portal.

Log in today to:

• Check claim status

• See remittance advice

• Check benefits and eligibility status

• Access our other applications and updates on the BlueCross-specific Payer Space

(continued on page 2, left column)

INSIDE THIS ISSUE

BlueCross BlueShield of Tennessee, Inc.

Use Availity® to Get the Answers You Need

Register for an All Blue Workshop 2019 in a City Near You

Updates to the Provider Dispute Resolution Procedure

Cite Guideline Transparency Tool Now Available

Allergy Immunotherapy Reimbursement Update

New Prior Authorization Requirements for Oncology/Radiation Therapy

Changes to High Tech Imaging Program Prior Authorization for Commercial Plans

New Prior Authorization Requirement for Provider-Administered Specialty Medications

Billing Accuracy and Cost Control

BlueCare Tennessee

Billing Guidelines for Retinal Use of Avastin (Bevacizumab)

Convert Sports Physicals to Well-Child Exams for Your BlueCare Tennessee Patients

Medicare Advantage

Bill Same Dates of Service on Same Claim

BlueCare Plus Model of Care Training

Step Therapy for Certain Medicare Part B Drugs

Quality Care Partnerships

Reimbursement Changes as Part of Our Medicare Advantage Quality+ Partnerships Incentive Program

1 | March 2019

QUALITY CARE QUARTERLY

Your Guide to Programs and Rewards

Featuring

– A message from our VP and Chief Medical Officer, Senior Products, Dr. J.B. Sobel

– Galen Group’s Successful Approach to Preventive Screenings

Winter 2018 - Volume 7

Your Guide for Quality Care MeasuresThe Quality Care Measures guide is printed annually, and includes:

• New HEDIS specifications for the year

• Suggestions for incorporating the information into current workflows

• Helpful tips and best practices

• Measure-specific inclusion and exclusion criteria

• Sample diagnoses, CPT® and HCPCS codes related to gap closure

• Measures descriptions, what service is needed and what to report

Quality Care Measures

QUALITY

COMMERCIAL 2020


Availity® Provider PortalAvaility® gives you the answers you need 24 hours a day, seven days a week . Through one convenient single sign-on, you can request claim status, view remittance advices and check benefits and eligibility status online .

In addition, the Quality Care Rewards tool located within Availity allows you to access the Quality Partnerships programs that apply to your practice . There you can identify gaps in care for your patients, attest to completed screenings, review your practice’s overall progress on quality measures and much more .

For FAQs and more information about using Availity, visit Availity.com/bcbst . You’ll also be able to sign up for a helpful webinar hosted by the Availity team .

eBusiness Technical SupportMonday through Thursday, 8 a .m . to 6 p .m ., ET and Friday, 9 a .m . to 6 p .m ., ETP: (423) 535-5717, Select Option 2Email: eBusiness_service@bcbst .com

East Tennessee

Faith Daniel(423) 535-6796Faith_Daniel@bcbst .com

Middle Tennessee

Faye Mangold(423) 535-2750Faye_Mangold@bcbst .com

West Tennessee

Debbie Angner(423) 535-2285Debbie_Angner@bcbst .com

For assistance or more information about Availity and the Quality Care Rewards tool, please contact your eBusiness Regional Marketing Consultant or our eBusiness Technical Support Team listed below:


Assistance with Supplemental Data CollectionYou’re already providing quality care to your patients, but sometimes we don’t receive the data needed to document that . Our annual supplemental data collection initiative helps us capture that information .

How it WorksFrom June through the first week of January, we provide nurses who can review your medical records to pull the data for closure of HEDIS measures that we haven’t received through claims or clinical data exchange .

Reviews can be completed through remote access or onsite visits . Your practice receives credit for all the information our team locates in your records . By closing these gaps, you can increase your quality scores .

Want to Learn More?For more information, contact a member of our team listed on the back of this guide . Participation is voluntary . This is not an audit, it helps document the quality services you’re already providing to your patients.


CAHPS Survey

A survey of perception and performanceCAHPS® is a family of surveys that measures topics that are important to members, such as communication skills of their providers and the accessibility of services . It’s considered the national standard for measuring and reporting on consumers’ experiences with health plans and their services .

The CAHPS surveys asks, “Are consumers satisfied with the quality of care and customer services provided by their health plan (such as BlueCross), and their providers?”

The survey provides a measurement of how our members (patients) perceive the care they receive from BlueCross-contracted doctors and providers .

What is CAHPS?Consumer

Assessment of

Healthcare

Providers and

Systems

Interactions with the PatientHow you interact with your patients has a direct impact on their response to the survey .

Provider ratings are based on the member’s perception of the provider’s ability to:• Provide timely appointments and care• Communicate information at the member’s level• Coordinate patient’s care by using information and reports from other

provider visits• Employ a helpful, courteous and respectful office staff


Tips for Improving Patient ExperienceIncorporating the following simple techniques into your daily interactions with patients will provide them with a better experience, help them achieve better health outcomes and can lead to better patient retention .

• Providing timely appointments

• Discussing care received from the Emergency Department and other providers

• Ensuring follow-up to communicate test results

• Offering assistance for needed appointments with specialists

• Discuss current medications and address any barriers to getting needed medication

• Reviewing current medications from all providers

• Submitting claims timely and accurately

The CAHPS survey measures the member’s perception of the care they have received .


Health Education Resources Available to MembersTo help reinforce the counseling and education you offer your patients, we offer a variety of informational resources on preventive care and chronic condition management for our members . These resources are distributed at member events and mailed to members upon request from outbound calls . We can also supply these to your staff for distribution to your patients . For All Adults

Care needs Ages Frequency Tips

Comprehensive

Diabetes

Screening

18–75 years

Yearly If you have diabetes, follow your doctor’s treatment plan to

help. These screenings and tests are needed as prescribed by

your doctor:

• Hemoglobin A1C: Keep your level less than 8.0%

• Eye exam: Dilated or retinal exam

• Kidney screening test

• Blood pressure control: Less than 140/90mmHg

Colorectal

Cancer Screening50 and older (younger

for high-risk)

Frequency

depends on

screening

selected

There are several options for colorectal cancer screenings:

• Colonoscopy: Every 10 years OR

• Sigmoidoscopy: Every five years OR

• CT Colonography: Every five years OR

• Fecal Immunochemical DNA Test (FIT – DNA): Every three

years OR

• Fecal (stool card) test or Fecal Immunochemical

Test (FIT): Yearly

Preventive Health

Exam Services

18–64 years

Yearly Annual exams can include blood pressure checks, cholesterol/

lipid blood tests and other screenings. Your doctor may also

screen you for STDs, obesity and depression.

Weight Management

18–74 years

Yearly A body mass index (BMI) check helps you manage

your weight.

Flu Vaccines 18–64 years

Yearly Adults should get flu vaccines and other immunizations

recommended by the Centers for Disease Control

and Prevention.

For Women

Care needs Ages Frequency Tips

Breast Cancer

Screening

(Mammogram)

50–74 years

Every 2 years Your doctor may suggest mammograms more often depending

on your medical history. Discuss this with your doctor.

Cervical Cancer

Screening

(Pap test)

21–64 years

Every 3–5 years Ask your doctor which screenings you should get:

• Age 21–29: Pap every three years

• Age 30–64: Pap every three years OR Pap and HPV testing

combo every five years

Prenatal and

Postpartum CarePregnant

womenDuring pregnancy

Early prenatal care is important, especially with a

high-risk pregnancy.

• 8-14 prenatal visits starting in the first trimester.

• Postpartum visit 21-56 days after delivery or within 42 days of

enrolling in your health plan.

Chlamydia

Screening

16-24 years

Yearly Sexually active women in this age group, including pregnant

women, should be screened yearly.

• Urine test OR cervical cell sample

HPV test (Human

papillomavirus)30 and older

Every 5 years Sexually active women should be tested every five years for

early detection of HPV and cervical cancer.

Health and wellness screenings help your doctor keep you healthy by preventing

illnesses and by spotting small problems early when they’re easiest to treat.

We’ve listed some basic guidelines below, but ask your doctor about which

screenings and recommendations are best for you.

Remember to keep your primary care doctor up-to-date about any other medical

care you receive (i.e. specialist visits, ER visits, Home Health, etc.) so they can

help coordinate your care.

Adult Preventive Health Screening Guide

For Children and AdolescentsCare needs Ages Frequency TipsWell Child Exams/Visits 0–6 years Depends on age

Frequency of visits:• Birth to 15 months: At least five or six visits• Ages 3 to 6: YearlyChildhood

Immunizations0–2 years Complete all

vaccines by 23 months of age

Centers for Disease Control and Prevention vaccine recommendations:

Certain vaccines are given as a series of doses. A child should receive all immunizations in their entirety for full effectiveness.Weight

Assessment and Management/Counseling

3–17 years Yearly Your adolescent’s primary care physician or OB/GYN should check Body Mass Index (BMI), document BMI percentile and provide nutrition and physical activity counseling. Adolescent

Well Care Visits12–21 years years

Yearly Preventive health physicals with your adolescent’s primary care physician or OB/GYN practitioner can include blood pressure checks, cholesterol/lipid tests and screenings to prevent or manage other conditions.

Adolescent Immunizations

9–12 years Complete before the age of 13

A child between 11 and 13 should have these vaccines in full dosages prior to turning 13.• One dose Meningococcal (Meningitis)• One dose Tdap/Td Vaccine (Tetanus, Diphtheria, Pertussis)

• Two doses of the Human Papillomavirus (HPV) vaccine at least six months apart OR three doses within a six-month period

Chlamydia Screening

16–24 years

Yearly Protect your adolescent’s reproductive health: Girls and women 16 years and older should get a chlamydia screening every year. This screening can be done with a simple urine test.Prenatal and

Postpartum CarePregnant women

During pregnancy

Early care is important, especially with a high-risk pregnancy.• 8–14 prenatal visits starting in first trimester. • Postpartum visit 21–56 days after delivery or within 42 days

of enrolling in your health plan.

Preventive care and screenings help your doctor keep your child healthy by preventing illnesses

and by spotting small problems early when they’re easiest to treat. We’ve listed some basic

guidelines below, but ask your doctor about which screenings and recommendations are best

for your child.

Child and Adolescent Preventive Health Screening Guide

• Four doses DTaP (Diphtheria/Tetanus/Pertussis)• Three doses IPV (Polio)• One dose MMR (Measles, Mumps, Rubella)• Three doses HiB (Haemophilus influenzae type B)

• Three doses Hep B (Hepatitis B)• One dose Hep A (Hepatitis A)

• One dose Varicella (Chickenpox)• Four doses PCV (Pneumococcal)• Two or Three doses RV (Rotavirus)• Two doses Influenza (Flu) & yearly thereafter

Get Screened for Peace of MindWHAT YOU SHOULD KNOW ABOUT COLORECTAL CANCER SCREENING

BREAST CANCER SCREENING

Living With

Diabetes


Outreach Campaigns to Targeted MembersThroughout the year, we identify members who may need preventive care, screenings or education on potential health issues, and send informative clinical messages to them through mail, email and automated phone calls . These campaigns include a focus on:

• COPD

• Immunizations

• Flu or pneumonia

• Appropriate antibiotic use

• CAD

• Colorectal cancer screening

• Low back pain

• Diabetes and statin use

Campaigns are also directed towards patients with chronic conditions to make them aware of their disease management benefits .

Get your blood pressure checked every time you see a nurse or doctor. Try to keep your blood pressure below 140/90 – and work with your provider to get to an even lower target of less than 130/80.Have cholesterol tests to measure the fat in your blood.Your doctor may prescribe a type of medication called a statin to help keep your heart healthy if lifestyle changes aren’t enough. Be sure to take it exactly the way your health care provider says to.

1 Cameron Hill Circle | Chattanooga, TN 37402 | bcbst.com

BlueCross BlueShield of Tennessee

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-565-9140 (TTY: 1-800-848-0298).

ھاتف الصم والبكم: 1-0298-848-800). ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-9140-565-800 (رقم

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-565-9140 (TTY:1-800-848-0298) 。

BlueCross BlueShield of Tennessee complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.For TDD/TTY help call 1-800-848-0298.BlueCross BlueShield of Tennessee, Inc. is an Independent Licensee of the BlueCross BlueShield

AssociationBlueCross BlueShield of Tennessee is a Qualified Health Plan Issuer in the Health Insurance Marketplace.

This information is not meant to take the place of your provider’s advice.

Source: Healthwise

We’re here to help. Find out more about managing heart disease at bcbst.com/HeartDisease.Heart-healthy choices help support a longer, healthier life. • Follow your doctor’s diet andphysical activity plan.• Stop tobacco use.• Limit alcohol use.• Talk to your doctor if you need helpwith depression or stress.

Noelle, to love life longer, love your heart.Here are some easy steps to keeping your heart healthy.

We're here to help. For more information, call us at 1-800-818-8581.

1 Cameron Hill Circle

Chattanooga, Tennessee 37402

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Living Your Best Life. We’re here to help.


Customized On-Site Events

On-Site Health Screening EventsThe BlueCross quality teams often host screening events that can be held in your office, on our mobile unit, or at a local community event . We can customize these on-sites to meet your needs or preferences .

Your patients are often able to close multiple gaps in care and receive important educational material .

Customized on-site events can include:• Well-Care/Screening Events

• Community Outreach

• Patient Education

Targeted Member Education and Assistance• Telephonic outreach offering education and assistance with

appointment scheduling for needed screenings

• Preventive Screening Campaigns

• Patient Brochures

Assistance in Closing Quality MeasuresPreventive care helps your patients improve their ability to lead healthy lives . But we know it’s not always easy to get patients in the office for these important visits . That’s why we give you other options for getting these screenings completed .

We offer customized onsite health screening events at your location tailored to best fit the needs of your office . Services we offer can include:

• Breast cancer screenings

• Colorectal cancer screenings

• Diabetic retinal eye exams

We identify members who could benefit from these screenings and schedule a convenient time for them . Our onsite events can also include community outreach and member education .

Our team will be onsite at your event to assist our vendor partners, provide support, answer questions and help educate your patients on the importance of prevention and screening tests . There is also the opportunity for you to conduct other services during the same visit, including:

• Annual wellness visit

• Blood pressure checks

• BMI assessments

To schedule an event, contact us at GM_Commerical_Quality_Improvement@bcbst .com

ColorectalCancer

Screenings

DiabeticScreenings

BreastCancer

Screenings


Member Wellness EventsEach year we hold wellness campaigns in communities across the state to help support your efforts to deliver quality care . Our goal is to make it easy for your patients to get the preventive care they need by bringing these events to their communities .

Member Wellness Event Campaigns include:• Breast Cancer Screening

• Colon Cancer Screening

• Retinal Eye Exams

• Drive Through Flu Shot Clinics

We’re coming to your neighborhood!


We’ve found these best-practices helpful to many of our members and their providers.Our Focus on

Medication AdherenceWe know you place an importance on educating patients on the benefits and risks of prescribed medication, and we’re here to help . We have a dedicated team that contacts patients who are not getting their prescriptions refilled as they should . We work with patients, their providers and pharmacies to help address the reasons the patients aren’t taking their medications as prescribed . Through these efforts, we strive to impact the following HEDIS quality measures relating to medication adherence: antidepressant medications, statin medications, ADD medications, and respiratory medications for asthma and COPD .

Encourage patients on an established maintenance medication regimen to use mail-order and 90-day supply options .

2

Write prescriptions the way you instruct your patients to take their medications .

1

Suggest patients use pill boxes and set reminders for refills .

5

Talk to your patients about the purpose of their medications and how they may make them feel .

3

Refer patients to our Care Management program, at 1-800-565-9140, for assistance with other barriers to medication adherence . We have nurse case managers, social workers, and dietitians available to help .

7

Schedule office visits and follow-up appointments prior to prescriptions running out .

6

Coordinate all prescription refills for the same time to help prevent gaps in therapy .

4


Individualized Member Health PlannersEach year we mail more than 500,000 health planners to members with at least one indicator that they may have a gap in care . The health planners are dynamically built with health indicators based on compliance status, and include health tips based on age, gender and disease condition .

These mailing usually begin in May or June for adults . Health planners for children are sent based on their birthdays . Our intent is to encourage our members to work with their primary care doctor to be proactive in preventing conditions, and in the management of chronic conditions .

Age Bands

• Child: Ages 0-15 (addressed to parent or guardian)

• Teen: Ages 16-17 (addressed to parent or guardian)

• Adult: Ages 18+

Sample- HEALTH PLANNER MeasuresSome measures apply only to certain insurance products based on

National Committee for Quality Assurance recommendations

INDICATOR MEASURES

Well-Child 0-6 yearsAdolescent Well-CareAdult Annual Wellness

Childhood ImmunizationsAdolescent ImmunizationsDental Cleaning & Exam

Eye ExamMetabolic Testing

Breast Cancer ScreeningCervical Cancer Screening

Colorectal ScreeningDiabetic Eye Exam

Diabetic NephropathyDiabetic HbA1c

Osteoporosis ManagementDrug Therapy for Rheumatoid Arthritis

HEALTH MESSAGES & TIPS

Prenatal & Postpartum CareLow Back Pain

COPD Medication AdherenceBeta Blocker Medication Adherence

Controlling High Blood PressureStatin Therapy

Transition from Pediatric to Adult Care

Asthma Appropriate Antibiotic Use

ADHD Medication Follow upDrug & Alcohol Abuse Treatment

Smoking & Tobacco Use CessationMental Illness & Depression Follow-up

We let the patients know if care is due soon, overdue or already done for the year based on the status symbol color.A status indicator shows recommended health screenings:§ Red: Screening is past due§ Yellow/Orange: Screening is

needed§ Some may also include a Green

status indicator to show that the member is up-to-date

Details about the needed screenings and their purpose


Focus for 2020 Health PlannersThese measures and care management messages reflect conditions and screenings that most often show as gaps in care .

Care Management Messages & Health Tips• Prenatal & Postpartum Care

• Use of Imaging Studies for Low Back Pain

• Pharmacotherapy Management of COPD Exacerbation

• Controlling High Blood Pressure

• Statin Therapy for Patients with Diabetes

• Statin Therapy for Patients with Cardiovascular Disease

• Medication Management for People with Asthma

• Appropriate Testing for Pharyngitis

• Appropriate Treatment for Upper Respiratory Infection

• Avoidance of Antibiotic Treatment with Acute Bronchitis

• ADHD Medication Follow up

• Initiation & Engagement of Alcohol and Other Drug Abuse Treatment

• Medical Assistance with Smoking & Tobacco Use Cessation

• Follow-up After Hospitalization for Mental Illness

• Antidepressant Medication Management

• Transition from Pediatric to Adult Care

• Flu Vaccinations

• Well-Child Visits in the first 15 months of Life (6+ visits) 0-6

Indicator Measures

• Annual Wellness (comprised of the following)

- Well-Child Visits in the first 15 months of Life (6+ visits) 0-6

- Well-Child Visits in the Third, Fourth, Fifth, & Sixth Years of Life

- Adolescent Well-Care

- Adults’ Access to Preventive/Ambulatory Health Services

• Childhood Immunization Status

• Immunizations for Adolescents

• Breast Cancer Screening

• Cervical Cancer Screening

• Colorectal Cancer Screening

• Comprehensive Diabetes Care

- Diabetic Retinal Eye Exam

- HbA1c control

- Nephropathy Screening

- Blood Pressure Control (guidance only)

• Metabolic Testing (for children on antipsychotics)

• Dental & Vision Check-ups


Healthy choices each day become healthy habits. Start now.

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BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace.

People with asthma may need short-term and long-term medicines to help control their symptoms. To help make sure you take the right medicine and the right dose at the right time make a plan with your provider. Talk with your doctor before you stop taking any medicine.

Source: American Lung Association – lung.org

ASTHMA MEDICINES

Doing a breast self-exam every month helps you notice small changes. If you find something, talk to your provider about whether you need a screening. The earlier breast cancer is found, the more likely it can be treated.

BREAST SELF-EXAM

Source: National Breast Cancer Foundation –nationalbreastcancer.org

See your provider or OB/GYN as soon as you think you’re pregnant – within your first trimester, if possible.

Keep all provider appointments before the baby is born.

After delivery, see your provider for a postpartum checkup within 21 to 56 days (three to eight weeks).

Source: March of Dimes – marchofdimes.org

PROVIDER VISITS = HEALTHY MOM AND BABY

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association

Sources: U.S. Preventive Services Task Force – uspreventiveservicestaskforce.orgMillion Hearts – millionhearts.hhs.govAmerican Cancer Society – cancer.org National Library of Medicine/ National Institutes of Health – nlm.nih.gov

Do you have questions about your health care plan? We’re here to help. Find our phone numbers on your Member ID card. Or visit us online at bcbst.com. Benefits may vary by plan. Please check your Evidence of Coverage. This information is educational only. It doesn’t replace your provider’s advice. It is based on your age, gender and health care claims with us as of __/__/__. We may not have record of some procedures, screenings, tests or vaccines. Talk to your provider about this information and any health concerns.BlueCross BlueShield of Tennessee complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. For TDD/TTY help call 1-800-848-0298.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-565-9140 (TTY: 1-800-848-0298).

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-9140-565-800 (رقمھاتف الصم والبكم: 800-848-0298-1).

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-565-9140 (TTY:1-800-848-0298) 。

Noelle Easy steps to help you stay healthy.

What you need Why you need it Your status

Physical Exam with your Primary Care Provider (PCP) or OB/GYN

Your PCP is your partner in health. Keep your PCP up to date on any care you get from other providers.

Make your appointment today. Date & Time:__________________________

Take this mailer with you to discuss.

Colorectal Cancer Screening

Finding colorectal cancer early could save your life. A colonoscopy is recommended as the “Gold Standard,” but this screening can also be completed via flexible sigmoidoscopy, CT colonography, FIT-DNA test, or a fecal occult blood test. Discuss with your doctor which option is best for you.


Breast Cancer Screening

A mammogram is an X-ray of the breast. It can find cancer before you or a provider discover a lump. Finding cancer early can save your life.

Cervical Cancer Screening

Regular Pap tests screen for cervical cancer. Treatment is more successful if this cancer is found early.


HbA1c Testing Checks your average blood sugar levels over the past three months. Controlling blood sugar helps prevent damage to your heart, kidneys and other vital organs.

Urine test for protein

Checks for signs of diabetic kidney disease (nephropathy). This important test makes sure your kidneys are functioning properly.

Retinal Eye Exam Checks for damage to your eyes. This is a medical test and doesn’t require vision benefits. See an eye doctor (ophthalmologist or optometrist) yearly.

Blood Pressure Screening

To keep your heart healthy, try to keep your blood pressure below 140/90 – and work with your provider to get to an even lower target of less than 130/80. Blood pressure control reduces risk of heart attack, stroke or kidney disease.

Up-to-dateNeeded by 12/31/2018Past due

Special Care for Women

Special Care for People with Diabetes

This information is based on your claims as of <date>."

Even if you’re healthy, regular visits with your primary care provider (PCP) are important:

To screen for diseasesTo encourage a healthy lifestyleTo update vaccinationsTo build a relationship in case of an illness Source: National Library of Medicine – nlm.nih.gov

REGULAR PROVIDER VISITS

Sample Health Planner with Health Indicators and Tips These measures and care management messages reflect conditions and screenings that most often show as gaps in care .

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Your Commercial Quality Improvement Team

Patty Howard, RN, BSN, CPHQ, FAHMManager, Quality Improvement

Office: (423) 535-7865 Patty_Howard@BCBST .com

Jessica Castano, RN, BSN, CPHQSupervisor, Performance and Process ImprovementOffice: (423) 535-6655 Jessica_Castano@BCBST .com

Lisa Eaves, RN, BS, CPHQ, PAHMCinical Consultant, Quality ImprovementMobile: (423) 326-4859Lisa_Eaves@BCBST .com

Shannon Dunn, BS, LPN, CPHQ, CHCClinical Consultant, Quality ImprovementMobile: (423) 298-3951Shannon_Dunn@BCBST .com

Jennifer Rollins, RN, MSN, CCM, PAHMClinical Consultant, Quality ImprovementMobile: (423) 240-0327Jennifer_Rollins@BCBST .com

Leigh Sanders, RN, CCMClinical Consultant, Quality Improvement

Mobile: (423) 702-1505Leigh_Sanders@BCBST .com

20PED752441 (02/20)

1 Cameron Hill Circle | Chattanooga, TN 37402 | bcbst.comBlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield AssociationCPT® is a registered trademark of the American Medical Association.HCPCS is the Healthcare Common Procedure Coding System.

This document is educational in nature and is not a coverage or payment determination, reconsideration or redetermination, medical advice, plan pre-authorization or a contract of any kind made by BlueCross BlueShield of Tennessee. Inclusion of a specific code or procedure is not a guarantee of claim payment and is not instructive as to billing and coding requirements. Coverage of a service or procedure is determined based upon the applicable member plan or benefit policy. For information about BlueCross BlueShield of Tennessee member benefits or claims, please call the number on the back of the member’s ID card. This document may not be reproduced, printed, photocopied or distributed without prior written consent from BlueCross BlueShield of Tennessee.

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