Past Issues

Blue Cross and Blue Shield of Florida (BCBSF) and Health Options now participate with the Council for Affordable Quality Healthcare’s (CAQH) Universal Credentialing DataSource (UCD). A single, online source for capturing credentialing information, UCD eliminates the time-consuming task of completing multiple credentialing applications. It is free to health care practitioners.

Overall compliance with nationally accepted standards is more than 90 percent for most documentation of care indicators, according to a review of the medical records of contracted primary care physicians in our Health Options (HMO) network. The annual review evaluates medical records against the standards; but it does not define standards of care, nor does it replace physicians’ clinical judgment.

The number of new diabetes cases is increasing at a staggering rate nationwide. The Centers for Disease Control (CDC) and Prevention predicts one in three children born after 2000 will develop diabetes in their lifetime. Further, children of African-American or Hispanic descent are almost twice as likely as Caucasians to develop diabetes over their lifetimes.

How much does resolving non-urgent health care needs by phone cost your practice in time, money and efficiency? A 1999 study by the Institute of Medicine estimated that 90 percent of all U.S. health care transactions took place by phone, costing the industry $280 billion annually in office staff, physician time, and telephone and fax expenses.1 But you can reduce labor-intensive phone calls and phone tag and automatically capture HIPAA-compliant documentation simply by signing up for e-Medicine.

Blue Cross and Blue Shield of Florida (BCBSF) debuted two health care debit cards¹ from MasterCard® Jan. 1, 2006—one through MBI Benefits and one through Mellon Financial Corporation. Debit cards provide payment at time of service.

On Jan. 1, 2006, Blue Cross and Blue Shield of Florida enhanced the ClaimCheck appeals process for all participating physicians and providers. A determination on all appeals will be made within 60 days of receipt of an appeal (includes weekends and holidays); and if a denial is upheld, the response will include detailed information covering the reason(s) for the denial.

During December, Blue Cross and Blue Shield of Florida upgraded its version of ClaimCheck®, the automated procedure code editing system used as part of our professional claims processing procedure. ClaimCheck is updated semiannually to keep pace with changes and developments in coding procedures.

Blue Cross and Blue Shield of Florida has revised its Multiple Surgery policy affecting reimbursement beginning Jan. 1, 2006. The policy applies when a single physician or physicians in the same group practice perform separate procedures on the same patient during the same operative session or on the same day for which separate payment may be allowed.

To better serve its users, Availity recently enhanced the Availity Gateway. You must be registered with Availity to access these services. If you are not registered, you can do so online at www.availity.com.

The Blue Cross and Blue Shield Association and Visa^® USA have entered into an agreement to support participating Blue Plans nationwide in offering their members co-branded debit cards to pay for health care-related expenses.

Depression affects about 20.8 million adults in the United States. People with depression are more likely to develop disabilities, miss work, be less productive, and spend more money and time on health care.

The American Lung Association (ALA) raised concerns about a 2004 report that ranked livable areas based on prevalence of asthma.

Blue Cross and Blue Shield of Florida’s HMO subsidiary, Health Options, will conduct its 2006 Health Plan Employer Data and Information Set (HEDIS®) study in physicians’ offices between March and May 2006.

On Jan. 1, 2006, Blue Cross and Blue Shield of Florida updated its fee schedules.

Physicians and providers in South Florida can use the Availty^®1 Gateway or BlueExpress to request routine after-hours authorizations for Health Options’ BlueCare, ActivelyYou and Medicare & More members. Call Utilization Management for urgent requests.

We have updated several of our online materials, including the Manual for Ancillary Providers, the Availity Users Manual for Physicians and Providers and the 835 Health Care Electronic Remittance Advice (ERA) Request Form.

Coverage under BlueScript for Medicare Part D, Blue Cross and Blue Shield of Florida’s new prescription drug plan for Medicare beneficiaries, begins Jan. 1, 2006.

For your convenience Blue Cross and Blue Shield of Florida’s three/tier Preferred Medication List and two/tier Drug Formulary are available on our website and can be downloaded to your Personal Digital Assistant (PDA) for viewing as needed.

The Preferred Medication List and the Blue Cross and Blue Shield of Florida (BCBSF) Drug Formulary are guides for members with three- and two-tier prescription drug plans, respectively.