Past Issues

Blue Cross and Blue Shield of Florida conducted research earlier this year to better understand physicians’ and their office/business managers’ expectations when doing business with us. The information is being used to identify what’s most and least important to you and to help us learn what we can do to improve our working relationship.

On Dec. 29, Blue Cross and Blue Shield of Florida is launching two interactive tools on its member website – Subimo’s Physician Selection Advisor and Healthcare Advisor. Educating members is increasingly important as more employers and individuals opt for consumer-driven health plans.

Three Medicare Advantage plans are available from Blue Cross and Blue Shield of Florida and its HMO subsidiary, Health Options.

Blue Cross and Blue Shield of Florida has launched three new BlueOptions plans with effective dates of Jan. 1, 2006.

Claim processing for national accounts with employees in Florida is being moved in phases to a common Blue Cross and Blue Shield of Florida system currently used for our regular HMO and PPO claims.

Blue Cross and Blue Shield of Florida diligently pursues timely recovery of overpayments to physicians and other providers as part of its effort to maintain stable premium rates.

Good news! Blue Cross and Blue Shield of Florida has implemented a processing change to accommodate professional claims submitted with multiple modifiers.

Physicians and providers can now update Health Care Services Review (i.e., authorization, certification, notification, referral, etc.) requests through the Availity¹ Gateway.

Blue Cross and Blue Shield of Florida’s (BCBSF) is moving all claims to a common claims processing system in phases, including BlueCard claims.

HEDIS^® scores on use of appropriate medications for asthma improved in 2002 for Blue Cross and Blue Shield of Florida’s HMO subsidiary, Health Options. A continued effort is needed, however, to raise performance above the national average.

The U.S. Preventive Services Task Force (USPSTF) has reviewed evidence regarding the effectiveness of mammography, clinical breast examination and breast self-examination in reducing breast cancer mortality.

Endometrial cancer is the fourth most common cancer in women. It will be diagnosed in more than 40,800 women in the United States—2,500 Floridians—and will be responsible for 7,310 deaths this year.

Blue Cross and Blue Shield of Florida offers a voluntary statewide Congestive Heart Failure (CHF) Program designed to help improve quality of life for members with CHF.

Diabetic retinopathy is the most frequent cause of new cases of blindness among adults aged 24-74 years.

Health Options’ participation in the Advanced Renal Options (ARO) program will end Dec. 31, 2005.

Federal Employee Program (FEP) benefit changes for 2006 include the addition of limited chiropractic benefits for the Standard Option plan and a reduction to a $100 per admission copay for inpatient maternity services for the Basic Option plan.

We continue to look for ways to make working with us easier by using electronic capabilities.

NetworkBlue is the participating network for all BlueOptions PPO point-of-service health plans.

Beginning Jan. 1, 2006, Blue Cross and Blue Shield of Florida (BCBSF) will complete conversion to the new non-Social Security based member ID numbers.

Medical directors with National Imaging Associates, Inc. (NIA) are a valuable resource for peer-to-peer consultation regarding radiology imaging procedures and specific cases regarding BlueCare, Medicare & More and ActivelyYou members.

The state of Florida has restructured its health care program to offer more choices and provide new tools and resources to help its employees find health care that fits their diverse needs.

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.

Health Options promotes open and free communication between providers and patients.

We congratulate physicians and other providers who maintain well-documented medical records.

Health Options has a financial incentives policy in place that is designed to assist practitioners, providers, employees, and supervisors involved in (or who supervise those involved in) making coverage and benefit utilization management or utilization review (UM/UR) decisions.

Health Options has accepted and approved standards established by the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services for accessibility services for its HMO members.

To help us meet member expectations, Health Options periodically conducts customer satisfaction surveys and analyzes a number of indicators that relate to effectiveness and accessibility of care, as well as use of services.

In an effort to assist members in making informed decisions about their health care, Blue Cross and Blue Shield of Florida provides a link on its website to the Florida Agency for Health Care Administration (AHCA).

Blue Cross and Blue Shield of Florida, Inc. and its HMO subsidiary, Health Options Inc., respect the privacy of our members and have policies and procedures in accordance with the Privacy Rule to safeguard personal information in all forms – spoken, written and electronic.

Health Options is committed to offering quality health care coverage as well as maintaining the dignity and integrity of our members.

The types of treatments, devices and drugs covered by Health Options are extensive.

Blue Cross and Blue Shield of Florida and Health Options share a concern about the safety of its members and support practitioners and providers in the endeavor to continually improve patient safety.

Health Options has established a process for reviewing a member’s complaints and grievances/appeals.

Health Options treating physicians have the opportunity to discuss any adverse determination based on medical appropriateness or necessity with the physician reviewer making the decision.

In our effort to continuously improve the health status of our members, we have adopted nationally recognized guidelines for preventive services and disease management.