Past Issues

On Oct. 16, physicians and providers in Jacksonville, Tampa and South Florida were the first to receive access to the much-anticipated CareCalc treatment cost-estimating tool through the Availity^®1 Health Information Network. The tool is being rolled out in a phased deployment throughout 2007.

Documentation of Care (DOC) reviews are conducted to promote patient safety and ensure continuity of care and continuous improvement.

Want to save time AND give your patients a secure, convenient way to schedule appointments, get normal lab and test results, receive refill prescription requests and ask simple questions without coming into your office? Join the growing number of physicians using e-Medicine.

On Oct. 1, 2006, we introduced our new BlueOptions^SM 100% plans. These new Physician Copayment and HSA-compatible plans are ideal for people who want a simple, straightforward plan and for those who want more certainty in their costs.

As part of our lower-cost BlueOptions^SM family of products, we are now offering Essentials – Routine Care plans for small groups with less than 50 employees and large groups that have 51 or more employees.

Some significant changes are on tap for our Medicare Advantage products. We’re offering Medicare beneficiaries new, lower-cost products, along with enhanced offerings for benefits effective Jan. 1, 2007.

An update to ClaimCheck scheduled for Nov. 11, 2006, will result in some coding logic changes. ClaimCheck is the automated procedure code editing system used in professional claims processing.

Effective Nov. 1, 2006, three procedure codes were added to the list of payable lab services when performed in the office by physicians participating in our NetworkBlue and Health Options (HMO) networks.

Claim processing for national accounts with employees in Florida continues to move in phases to the common Blue Cross and Blue Shield of Florida (BCBSF) system currently used for our HMO and PPO claims.

On Jan. 1, 2007, we will begin processing Florida State Employees’ PPO Plan claims on the system presently used to process claims for HMO, NetworkBlue, most BlueCard^® host, and some BlueChoice and NASCO Control Plan claims.

Availity conducts one-hour training using web and phone conferencing tools, allowing physician and provider staff to attend using the Internet and your phone. Availity refers to these training sessions as "webinars."

Jan. 1, 2007, is the effective date for the launch of the new Blue Precision program that some Blue Plans outside Florida are offering to large national employers. Sponsored by the Blue Cross and Blue Shield Association (BCBSA) and administered through BlueCard^®, the Blue Precision program offers open access to a high performance network and differentiated benefit options. No referrals are needed.

On Nov. 3, 2006, the Centers for Disease Control and Prevention (CDC) announced that physicians should resume routine vaccination with tetravalent meningococcal polysaccharide-protein conjugate vaccine (MCV4) for all recommended groups, including children aged 11 to 12 years.

The U.S. Departments of Agriculture (USDA) and Interior (DOI) have confirmed that no avian influenza virus has been found in various samples collected from wild birds in six states (MI, MD, PA, MT, IL and OH).

On Oct. 1, 2006, Blue Cross and Blue Shield of Florida (BCBSF) began contracting with qualified outpatient clinics associated with both psychiatric and substance abuse facilities and community mental health centers.

With all the varying health coverage plan options available for members, physicians will see some patients selecting tailored health coverage plans that cover specific services, thereby expanding the list of noncovered services.

Current services being provided to HMO members by non-contracted companies will be transitioned to an EMP provider and will require a new prescription from the ordering physician.

The Blue Cross and Blue Shield of Florida Health Options HMO Manual for Physicians has been updated.

The following represents changes to the current Medicare Part D formulary effective Aug. 1, 2006.

In 2007, Blue Cross and Blue Shield of Florida will offer Medicare beneficiaries three Medicare Part D plan options.

The Preferred Medication List is a guide for members with three-tier prescription plans. Quarterly, pharmacists and medical professionals review the list to ensure it includes safe, cost-effective medications and reflects changes in the availability of certain drugs.

Blue Cross and Blue Shield of Florida (BCBSF) is preparing to transition pharmacy benefit managers from Medco to Prime Therapeutics LLC^® (Prime) Jan. 1, 2007. Prime will provide services to more than 1.4 million BCBSF members enrolled in health plans that include prescription drug coverage.

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 & Medicaid Services for accessibility services for its HMO members.

To help 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. HEDIS scores help to identify areas of improvement, as well as opportunities for action. The accompanying table compares Health Options’ 2006* HEDIS scores to the national average.

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 providing quality health care coverage at a reasonable cost while maintaining the dignity and privacy of our Members.

The Consumer Assessment of Health Plan Survey (CAHPS^®) results report member satisfaction with services provided by their doctors and health plans.

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. In light of the rapid changes in medical technology, it is important to continually look at new medical advances to determine which will be covered by our health plan.

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.

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.