Past Issues

In April, Blue Cross and Blue Shield of Florida launched The Power of the Human Voice—a forum for people throughout Florida to share their views, ideas and experiences about health care. From the multitude of voices certain common themes have emerged.

In 2007, Blue Cross and Blue Shield of Florida/Health Options (BCBSF), along with 23 other Blue Cross and/or Blue Shield plans from across the country, reached a settlement in the class action lawsuit known as Love, et al v. Blue Cross and Blue Shield Association, et al (formerly known as Thomas, et al v. Blue Cross and Blue Shield Association) (the “Settlement”). This case, involving claims processing and payment issues, was brought on behalf of physicians, physician groups and physician organizations.

Blue Cross and Blue Shield of Florida (BCBSF) announced the formation of a new Physician Advisory Committee (PAC) composed of representatives from our statewide network of physicians. PAC members were chosen in mutual agreement with the Florida Medical Association and will meet a minimum of every six months.

In June, physicians who use the Availity^®1 Health Information Network began to enjoy the benefits of a true end-to-end ePrescribing solution that takes only seconds to use!

Blue Cross and Blue Shield of Florida (BCBSF) has introduced several new BlueOptions plans as part of our commitment to meet the needs of the changing marketplace. The new plans include four Large Group and three Small Group BlueOptions^® plans, as well as three BlueScript^® Large Group pharmacy plans. Each has an effective date of July 1, 2008.

The benefits of our Medicare Advantage plan BlueMedicare^SM HMO are designed to save members time and money when accessing medical services. Physicians can play a large role in helping members make the best use of their benefits and realize significant savings.

Blue Cross and Blue Shield of Florida (BCBSF) has developed a single solution that provides consumers with a simple way to purchase, enroll and use both medical and dental coverage. On July 1, 2008, we introduced four BlueOptions Health and Dental plans for individuals under 65 that combine dental benefits with the health benefits of our Predictable Cost Plans.

Quite often when submitting a paper (UB-04) claim, providers add a summary line totaling the lines and codes billed on the claim. However, a summary line is not a required element of claims submission, and its inclusion can cause overpayments.

On June 28, 2008, Blue Cross and Blue Shield of Florida, Inc./Health Options updated its reimbursement policy for a problem-oriented evaluation and management (E/M) code billed with a preventative medicine E/M code on the same date of service for the same patient.

On May 19, 2008, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) introduced to individual professional providers the first tool in the health care industry to combine patient eligibility and financial responsibility with real-time claim adjudication.

Physicians and providers using electronic data interchange (EDI) or batch processing can now electronically submit corrected claims to Blue Cross and Blue Shield of Florida (BCBSF) using the Availity^®1 Health Information Network.

According to Current Procedural Technology (CPT), a new patient is one who has not received any professional services from the physician, or another physician of the same specialty that belongs to the same group practice, within the past three years. The new patient visit CPT codes are 92002, 92004, 99201-99205, 99324-99328, 99341-99345 and 99381-99387. The new patient visit HCPCS codes are G0245, S0610 and S0620.

In May, the Advisory Committee on Immunization Practices (ACIP) issued its first statement recommending routine immunization of all persons aged 60 years and older with one dose of live attenuated zoster vaccine to prevent herpes zoster (shingles). In its statement, the ACIP said, “The availability of a safe and effective vaccine for zoster offers an opportunity to decrease the burden of this disease and its complications among persons with high levels of risk.”

Effective July 1, 2008, Crestor^® was added to the Preferred Medication List, while Lipitor^® and Vytorin^® were removed. Lipitor and Vytorin remain covered under the pharmacy benefit; however, members with a three-tier pharmacy benefit may be required to pay a higher amount for these two brand-name drugs. The generic medications simvastatin, pravastatin and lovastatin are covered at tier 1 at the lowest cost for members.

The Centers for Medicare & Medicaid Services (CMS) published in the April 7, 2008, Federal Register the final rule on additional standards for electronic prescribing done under Medicare Part D. The rule went into effect June 6, 2008.

Two components of our Responsible Rx pharmacy program for BlueOptions and BlueCare HMO members expand as of July 1, 2008. Responsible Rx refers to an umbrella of Blue Cross and Blue Shield of Florida and Health Options programs, including Responsible Quantity, Responsible Step and Responsible Dose.

For the second consecutive year, Blue Cross and Blue Shield of Florida was named the health plan with the highest member satisfaction in the state of Florida, according to the J.D. Power and Associates’ National Health Insurance Plan Study.^SM

On July 15, 2008, Blue Cross and Blue Shield of Florida (BCBSF) will launch a Diabetic Supply Network to serve members of our BlueChoice, BlueMedicare PPO, BlueOptions and Traditional plans who obtain diabetic supplies through their medical (not pharmacy) benefit.

Florida ranks third in the nation for the highest number of uninsured among the states.

On May 23, 2008, the Centers for Medicare & Medicaid Services (CMS) began requiring physicians and other providers to use only their unique National Provider Identifier (NPI) in all provider identifier fields on HIPAA-covered electronic transactions.

It's summer-and that means it's hurricane season again. Successful emergency preparation is a top priority at Blue Cross and Blue Shield of Florida (BCBSF).