Past Issues

Blue Cross and Blue Shield of Florida, Inc. (BCBSF) and our HMO subsidiary, Health Options, Inc., are committed to quality care and service. We fully support the standards established by federal and state regulatory agencies and the National Committee for Quality Assurance (NCQA). This special section of BlueLine focuses on the policies that are in place to protect members and provides the results of NCQA’s most recent Health Plan Employer Data and Information Set (HEDIS^®) and Consumer Assessment of Health Plan Survey (CAHPS^®) surveys.

The National Committee for Quality Assurance (NCQA) is an independent, non-profit organization whose mission is to evaluate and report on the quality of the nation’s managed care organizations.

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).

NCQA’s Consumer Assessment of Health Plan Survey (CAHPS^®) reports on member satisfaction with services provided by their doctors and health plans.

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

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.

We congratulate physicians and other providers who maintain well-documented medical records. Accurate documentation facilitates communication, coordination and continuity of care for our members.

Physicians who treat Health Options members have the opportunity to discuss any adverse determination based on medical appropriateness or necessity with the physician reviewer making the decision.

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.

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

Initiate admission certification, notification and authorization requests electronically through the Availity^®1 Health Information Network.

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 look at new medical advances continually to determine which will be covered by our health plan.

Case Management involves early identification of members with serious catastrophic and/or chronic health problems. By identifying problems in advance the care coordinator has a better opportunity to better facilitate cost-effective, quality health care to meet a member’s needs. The services are voluntary and offered at no additional cost.

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.

The Health Options Quality Improvement (QI) program uses an organized, systematic and coordinated approach to quality improvement. We monitor and evaluate selected areas of focus and take action as appropriate to achieve measurable improvement in the quality and safety of clinical care and the quality of service provided to our members.

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