Past Issues

The National Committee for Quality Assurance (NCQA) has awarded the status of "Excellent" to Blue Cross and Blue Shield of Florida’s HMO subsidiary, Health Options, for its commercial HMO plan.

In response to the more than 2,200 messages now recorded on the Power of the Human Voice (POHV) website, Blue Cross and Blue Shield of Florida (BCBSF) has released a series of video presentations of BCBSF leaders addressing the health care concerns and questions posed by Floridians.

With the New Year comes a change in health care coverage for many of your patients. Deductibles will be resetting, and more members than ever will be enrolled in a high-deductible plan tied to a health savings account (HSA) to pay for out-of-pocket costs.

In response to requests from physicians in our networks, Availity^®1 CareProfile^® began providing in November pharmacy information and lab results for our 325,000 Blue Cross Blue Shield Service Benefit Plan federal members.

Beginning Jan. 5, 2009, Blue Cross and Blue Shield of Florida (BCBSF) is offering two Cover Florida plans statewide to individual Florida residents ages 19 to 64.

Physicians and providers in Miami-Dade, Broward and Palm Beach counties who participate in the Beech Street Consumer Card Network may be seeing an increasing number of patients with Blue Cross and Blue Shield of Florida’s (BCBSF) new FamilyBlue Medical Discount Card.

Since first launched in February 2008, our GoBlue Health Services Card has continued to grow, with customers across all life stages—from young singles to families to early retirees—finding value in the product.

Blue Cross and Blue Shield of Florida will launch a new product and network Jan. 1, 2009, called BlueSelect, targeted at addressing the needs of the state's nearly four million people who are uninsured, including 1.2 million working uninsureds, as well as those facing the prospect of going without insurance.

Under new Centers for Medicare & Medicaid Services (CMS) guidelines effective Jan. 1, 2009, Medicare Advantage group HMO and PPO members can enroll in their group’s health plan, even if they live outside the state where that group is headquartered and outside the service area, including the state, of the Blue Plan administering the group plan.

During November and December, Blue Cross and Blue Shield of Florida (BCBSF) made changes to the patient responsibility information and code definitions, and reduced forced balancing on the 835 electronic remittance advice (ERA).

On Dec. 6, 2008, Blue Cross and Blue Shield of Florida (BCBSF) updated its automated procedure code editing system, ClaimCheck^®, resulting in some coding logic changes.

Blue Cross and Blue Shield of Florida offers Electronic Funds Transfer (EFT) services for most claim payments.

Blue Cross and Blue Shield of Florida (BCBSF) sends monthly Statement of Account reports, which summarize outstanding overpayments, to providers.

Each year an estimated two million cases of chlamydia go undiagnosed and untreated, leading to serious health consequences for women. Often, chlamydia does not produce symptoms.

The Centers for Disease Control and Prevention (CDC) recommends adults 60 years old or older receive the Zostavax vaccine to prevent herpes zoster (shingles).

Pharyngitis is the only condition among upper respiratory infections (URIs) where diagnosis is objectively validated with a streptococcus A test (rapid assay or throat culture).*

The cost for physicians to purchase vaccines for their patients continues to rise. Various medical and physician associations recommend physicians join a vaccine purchasing program.

About 48 percent of 2,011adults responding to a Consumer Reports Health survey said they would not get vaccinated against the flu this season, despite the fact that flu is preventable.¹

Low back pain is among the most common musculoskeletal conditions, afflicting approximately 31 million Americans, and is among the top 10 reasons patients visit their providers.¹

Beginning Jan. 1, 2009, Blue Cross and Blue Shield of Florida/Health Options implemented a safety edit program affecting claims for rosiglitazone maleate-containing products (Avandia^®, Avandamet^® and Avandaryl^®).

Beginning Jan. 1, 2009, over-the-counter (OTC) loratadine and loratadine-D will be added to the Preferred Medication List as tier one medications under some BlueOptions plans. A prescription is required to qualify for coverage.

Blue Cross and Blue Shield of Florida and Health Options are targeting members under 65 who are prescribed warfarin (Coumadin^® and Jantoven^®) for a special education program.

Effective Jan. 1, 2009, Blue Cross and Blue Shield of Florida/Health Options has implemented a prior authorization requirement for coverage on all oral fentanyl products (Actiq^®, Fentora^®) and oral Zyvox^®.

Pre-market clinical studies do not reveal every possible problem that might occur once a product is widely used by the general population.

Effective Jan. 1, 2009, Blue Cross and Blue Shield of Florida and Health Options will expand two components of our Responsible Rx pharmacy program for BlueCare, BlueChoice and BlueOptions members.

Many patients take more than five medications per month prescribed for chronic conditions by two or more physicians. Statistics indicate that one in 10 people 60 or older take seven or more prescription medicines.

Blue Cross health insurance coverage for international Blue members from Jamaica has terminated. These members carried ID cards with alpha prefix JAM.

A number of changes in benefits and requirements have been made to the Blue Cross Blue Shield Service Benefit Plan for federal employees.

Blue Cross and Blue Shield of Alabama (BCBS of Alabama) has contracted with Care Core National, LLC (CCN) to implement a diagnostic imaging utilization management program to self-funded groups, such as PSS World, beginning Jan. 1, 2009.

Blue Cross and Blue Shield of Florida (BCBSF) and Health Options are replacing member health care ID cards with new magnetic stripe ID cards.

Beginning Jan. 1, 2009, Orlando area physicians and providers may see employees of Wheeled Coach Industries, who are newly covered by Blue Cross and Blue Shield of Kansas through the BlueCard^® program.

As part of its commitment to become a culturally competent health leader, Blue Cross and Blue Shield of Florida recognizes there are unique issues facing gay and lesbian members.

In December, Blue Cross and Blue Shield of Florida launched FloridaSaludable.com, a new website designed specifically for Spanish-speaking consumers.

Beginning 2009, enrollees in the State Employees’ PPO Plan can add a qualified dependent up to the age of 30 to their health insurance coverage.

We are eagerly awaiting the U.S. Department of Defense’s decision on who will be awarded the TRICARE contract to provide network services for the South Region.