Past Issues

It’s time to think about flu season again. Influenza vaccination is the primary method for preventing influenza and its severe complications.

A recent Documentation of Care (DOC) review of primary care physicians participating in our Health Options (HMO) network showed a significant decline in the documentation of advance directives in a random sampling of members’ medical records.

Physicians and providers who participate in Blue Cross and Blue Shield of Florida (BCBSF) networks must register their National Provider Identifiers (NPIs) with us. Currently, we are receiving more than 25 percent of inbound electronic transactions (i.e., claims) that contain NPIs that have not been registered.

Physicians and hospitals throughout Florida are now able to access the nation's first multiple-payer electronic health record, the Availity^®1 Care Profile^SM.

In July, electronic prescribing vendors from around the country joined ePrescribe Florida and representatives from public health organizations, medical associations and pharmaceutical networks for a two-day meeting in Jacksonville to develop informational resources for physician offices to use when selecting and implementing electronic prescribing.

Effective Sept. 1, 2007, Quest Diagnostics Inc. is Blue Cross and Blue Shield of Florida's (BCBSF's) preferred statewide laboratory provider for BlueChoice (Preferred Patient Care Network) plans. While members have open access under BlueChoice, Laboratory Corporation of America (LabCorp) and several independent laboratory providers have been terminated from the BlueChoice network as of that date.

Blue Cross and Blue Shield of Florida is expanding its Disease Management Education Program for Medicare Advantage – BlueMedicare HMO and BlueMedicare PPO – members. Since January 2007, the Disease Management Program has supported members with heart failure, diabetes and asthma utilizing evidence-based clinical practice guidelines.

Blue Cross and Blue Shield of Florida’s (BCBSF) latest offering for the group retiree and individual Medicare market is a private-fee-for-service (PFFS) plan. BlueMedicare PFFS1 will be available for sale statewide this fall for coverage beginning Jan. 1, 2008.

On Aug. 13, 2007, institutional claims for members in the Federal Employee Program (FEP) began processing on a different system. Blue Cross and Blue Shield of Florida (BCBSF) is moving all claims processing to a common claims system to be more efficient and consistent. We expect to complete the transition and have claims for all lines of business processing on the common system in 2008.

Blue Cross and Blue Shield of Florida (BCBSF) is implementing the following improvements to the 835 electronic remittance advice, an electronic version of a paper remittance advice provided through the Availity^®1 Health Information Network.

Physicians now have an online option for processing Medicare Part D vaccine claims electronically. eDispense^TM Part D Vaccine Manager, a product of Dispensing Solutions, Inc., is a web portal that provides physicians with real-time claims processing for in-office administered vaccines.

Claims processing for national accounts on the NASCO processing system with employees in Florida continue to move in phases to the BlueCard claims processing system. This change is being made to streamline administration. Thus far in 2007, approximately 42 national accounts have been migrated to BlueCard.

If you are a Medicare participating provider, you might be seeing members from around the country who are insured under a Blue Cross and/or Blue Shield Medicare Advantage Private Fee for Service (MA PFFS) plan.

In June 2007, the U.S. Preventive Services Task Force (USPSTF) updated its screening recommendations for the detection of chlamydia.

According to a study commissioned by the Agency for Healthcare Research and Quality (AHRQ), older, less-expensive agents have similar or superior effects on glycemic control, lipids and other intermediate end points as newer, costlier agents in the treatment of adults with type 2 diabetes mellitus.

Blue Cross and Blue Shield of Florida’s polypharmacy program is contacting members identified as taking more than five maintenance medications monthly prescribed by more than one physician. Members meeting these criteria are at higher risk for adverse effects, drug interactions and noncompliance.

Always use the online Availity^®1 Health Information Network for the quickest and easiest way to request Health Care Services Review (authorizations or certifications). But if the Availity system is down, our automated telephone system, BlueExpress, provides a great alternative.

Last month the Centers for Disease Control and Prevention (CDC) launched a campaign to educate parents about new vaccination recommendations for children ages 11 and 12. The CDC recommends MCV4 to protect against meningitis and the Tdap booster for tetanus, diphtheria and pertussis. Girls should be vaccinated against HPV.

Blue Cross and Blue Shield of Florida has launched its Discounts from Blue program for participating physicians and providers. This unique program offers discounts on select products and services for your office or personal life. This free program is offered to you as a token of our appreciation for the care you provide and the value you bring to the lives of our members.

In an effort to increase member immunization rates across the state, Blue Shield and Blue Shield of Florida (BCBSF) and Health Options encourage providers to register and use the Florida State Health Online Tracking System (Florida SHOTS).

Effective August 15, 2007, Blue Cross and Blue Shield of Florida’s HMO subsidiary, Health Options, eliminated the preauthorization requirement for hyaluronan injections administered to BlueCare^® HMO and BlueMedicare^SM HMO members. The move is part of a companywide effort to streamline processes, making it easier for physicians and providers to do business with us.