Past Issues

We want to create a more personally relevant health care experience not only for those seeking care but for those providing care.

Beginning in May, Health Options, Blue Cross and Blue Shield of Florida’s HMO subsidiary, will target by mail BlueCare and BlueMedicare HMO women age 50 and older who have had a recent fracture, advising them to discuss osteoporosis testing and/or treatment with their primary care physicians.

Authorized physicians and other health care providers in Florida now have access to two years of medical claims history for Federal Employee Program (FEP) members on Availity^®1 CareProfile^SM. The 400,000 FEP members were added to the program in March, bringing the total number of members on CareProfile to 2.9 million.

Blue Cross and Blue Shield of Florida’s BlueMedicare PFFS^SM1 provider website has been updated with comprehensive information about our Medicare Advantage Private Fee-for-Service (PFFS) plan.²

Blue Cross and Blue Shield of Florida (BCBSF) continues to make improvements to the 835 electronic remittance advice in response to your feedback. Enhancements implemented in April will be followed by others in June 2008.

Based on feedback from physicians and providers, Blue Cross and Blue Shield of Florida (BCBSF) and its HMO subsidiary, Health Options, Inc., have enhanced paper remittance advices for BlueOptions, BlueCare (HMO) and BlueMedicare HMO claims. The information added to the remittance advices makes it easier for physicians and providers to reconcile their accounts.

On April 12, 2008, an update to ClaimCheck^® resulted in some coding logic changes. ClaimCheck is the automated procedure code editing system used in professional claims processing.

In our effort to reduce claim overpayment occurrences and make the recovery process more efficient, we consolidated all departmental addresses to one secure bank lockbox for all refund payments.

Processing claims in a timely manner is a priority at Blue Cross and Blue Shield of Florida (BCBSF). To prevent processing delays, be sure to complete claims correctly the first time with all information completed in its entirety.

Following these helpful tips will improve your BlueCard^® claim experience.

The Advisory Committee on Immunization Practices (ACIP) has removed its previous preference for administering combination measles, mumps, rubella and varicella (MMRV) vaccine (ProQuad^®) over separate injections of equivalent component vaccines (i.e., measles, mumps, and rubella [MMR] vaccine and varicella vaccine).

Acute bronchitis consistently ranks among the 10 conditions that account for most ambulatory office visits to U.S. physicians. Despite the fact that the majority of acute bronchitis cases have a nonbacterial cause (>90%), antibiotics are prescribed 65 percent to 80 percent of the time, according to the 2008 Healthcare Effectiveness Data and Information Set (HEDIS^®) Guideline.

Coronary heart disease (CHD) is the major cause of mortality for persons with diabetes. It is also a major contributor to direct and indirect costs of diabetes. It is estimated that more than 20 percent of individuals with diabetes will develop CHD or have a recurrent CHD event within 10 years. Statin monotherapy has been shown to decrease coronary risk in diabetics.^1,2

On May 15, 2008, Caremark Specialty Pharmacy Services joins all Blue Cross and Blue Shield of Florida (BCBSF) and Health Options networks as a participating provider for certain specialty pharmaceutical medications.

As patients with consumer-directed health plans take on more out-of-pocket financial responsibility, they are likely to want to know the costs of services upfront, prior to receiving care. CareCalc^® takes the guesswork out of determining how much you should collect from the member. It estimates a patient’s financial responsibility prior to or at the point of care.

In our efforts to make the Manual for Physicians and Providers more user friendly, we have divided it into two parts: Part I - Administrative Information and Part II - Provider Specific Billing and Coding Guidelines.

The option many physicians have been asking for is finally here. Blue Cross and Blue Shield of Florida (BCBSF) has simplified the physician contract by introducing a single agreement for all of our insurance networks. This new option will make it easier to manage and understand physician contracts.

Effective April 1, 2008, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) welcomed the Independent Colleges and Universities Benefits Association (ICUBA) to BlueChoice and BlueOptions.