Past Issues

A sea change is occurring in the health insurance market. The movement is part of the growing need to address rising health care costs, which have doubled since 1992 and are expected to double again by 2013.

Obtaining the right care at the right time in the right setting has taken on greater significance as members’ health plans provide greater options for choosing the location and attendant cost for care.

The Administrative Simplification Provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA-AS) mandates the use of a National Provider Identifier (NPI) by covered entities in standard electronic health care transactions beginning May 23, 2007.

The Diagnostic Clinic in Largo and Clearwater launched its e-Medicine service last September.

Beginning April 1, BlueCare HMO members can now enjoy the same services of Health Dialog that have been available to BlueOptions and BlueChoice PPO members since 2003.

On April 1, BlueOptions and BlueChoice members will have access to Treatment Cost Advisor from Subimo. It is another tool in the arsenal we provide to help members keep a lid on their health care costs.

Quest Diagnostics Incorporated is the preferred laboratory for both NetworkBlue and Health Options.

In an effort to meet the needs of the chiropractic community, we have added to our website a new Chiropractic Specialty Billing Guide.

An update to ClaimCheck scheduled for April 8, 2006, will result in some coding logic changes. ClaimCheck is the automated procedure code editing system used in professional claims processing.

It’s happened to you time and again – a patient presents an old ID card. With the health care contract ID number conversion of 5.3 million members completed Dec. 31, 2005, our members should be presenting their new cards.

BlueOptions members have access to both NetworkBlue and our Traditional network.¹ The in-network benefit applies when they receive services from physicians and providers in NetworkBlue.

Did you know Availity offers an online help tool to all users? The Help button is located at the top of the screen when you logon to the Availity^® Gateway and is identified by a yellow question mark.

How’re we doing? Let us know! As a participating BlueCard Program provider, your satisfaction with the program is our top priority.

To simplify and streamline claim submission, the Centers for Medicare & Medicaid Services (CMS) is transferring the claims crossover functions from individual Medicare contractors to a national Coordination of Benefits Contractor (COBC).

Many individuals who have asthma triggered by allergies feel overwhelmed when faced with instructions on what to do in their home to help reduce potential allergy triggers.

Both the U.S. Senate and House approved bills last year providing for a reversal of Medicare’s 4.4 percent reduction planned for Jan. 1, 2006. However, the final bill updating the Medicare conversion factor for 2006 to zero percent was not signed until Feb. 8, 2006.

BlueNews Seminars are a great way for administrators, office managers and other provider staff to learn about Blue Cross and Blue Shield of Florida (BCBSF) programs and processes and to offer us feedback on ways to improve our processes, educational efforts and physician satisfaction.

We continue to expand our Advantage65^SM Select and Premier Select networks for Medicare beneficiaries. Two hospitals in Naples, Fla., were added March 1, 2006. They are Naples Community Hospital and North Collier Hospital.

In March, we began our annual review of medical records for HMO participating physicians. Medical records are permanent, legal documents and an important element in the evaluation of patient care and safety, as well as the delivery of continuity of care.

Blue Cross and Blue Shield of Florida has enhanced its care management programs, integrating various components. The new model provides members, physicians and providers with a central point of contact—locally based care coordinators.

Blue Cross and Blue Shield of Florida is expanding its Responsible Rx program April 10, 2006, with the addition of four medications used to treat nausea and vomiting. This change applies to all BlueCare, BlueChoice and BlueOptions members with pharmacy benefits.

Antimicrobial drug resistance continues to be a major health crisis. Widespread use of antimicrobials has resulted in increased cases of resistant gram-negative and gram-positive bacilli.

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. Quarterly, pharmacists and medical professionals review the lists to ensure they include safe, cost-effective medications and reflect changes in the availability of certain drugs.

The Generic Copay Waiver Program, which began in January of this year, has been successful in moving members from brand-name heartburn medications to omeprazole, the generic equivalent of Prilosec^®. Members taking Prilosec or similar brand-name medicines have had their first copayment waived when switching to omeprazole.

The May 15 deadline for enrolling in Medicare Part D prescription drug coverage is fast approaching. We encourage you to help people with Medicare who have not enrolled in Part D get the information and support they need to enroll in the prescription drug coverage program prior to the deadline so they can start saving on their prescriptions.