Past Issues

The height of the hurricane season is upon us. And with it comes the possibility of disruptions in our business activities.

Physicians and parents can now download a free software program from the Centers for Disease Control and Prevention (CDC) website to create personalized immunization schedules for children. The program can be particularly helpful when one or more vaccinations are missed, and it ensures that missed and future vaccines are given without violating guidelines regarding vaccines and doses.

Recording and tracking childhood immunizations has never been easier or more secure thanks to the Florida State Health Online Tracking System (Florida SHOTS). A program of the Florida Department of Health Bureau of Immunization and supported by the Centers for Disease Control and Prevention, the centralized web-based registry is free to authorized users.

From appointment scheduling through billing and claims follow-up, using Availity^®1 can help to increase a practice’s administrative efficiencies, reduce costs and improve the patient experience.

In September, physicians who use the Availity^®1 Health Information Network can begin to electronically write and send prescriptions directly to a patient’s pharmacy of choice with CarePrescribe^SM. The new application takes inefficiencies out of the prescribing process and closes the electronic loop between the physician and the pharmacist.

Want to learn more about BlueMedicare^SM PFFS? For your convenience, Blue Cross and Blue Shield of Florida (BCBSF) has compiled everything you need to know about our Medicare Advantage Private Fee-for-Service (PFFS) plan into the Physician and Hospital Reference Guide, a handy desktop manual. Call us now and we’ll send it directly to your office.

In September, Blue Cross and Blue Shield of Florida plans to enhance its 835 electronic remittance advice (ERA). Changes will affect coordination of benefits (COB), Medicare crossover(s) and patient responsibility. Some providers’ practice management systems or health information systems may require updates to support these changes.

Some preventative vaccines for Medicare beneficiaries are covered under Medicare Part D. This includes their administration fee. Providers should not bill the Part D vaccine administration fee to Part B.

The Blue Cross and Blue Shield of Florida, Inc. (BCBSF) and Health Options, Inc. list of Significant Claim Edits is now available on Availity’s^®1 website and will be updated annually in accordance with the Love Settlement Agreement.

Blue Cross and Blue Shield of Florida (BCBSF) has developed a new report that shows outstanding overpayments, making it easier for providers to reconcile accounts. The Statement of Account report gives a summary of the refunds received and outstanding. We began sending this monthly report last April to all providers who received an overpayment request refund letter(s) from BCBSF.

Effective Oct. 1, 2008, Blue Cross and Blue Shield of Florida (BCBSF) will require Present on Admission (POA) indicators to be submitted with all primary and secondary diagnosis codes on inpatient acute care hospital claims submitted for all BCBSF members.

Recent legislation has changed the time frame for health insurers and physicians to recover claim overpayments or underpayments.

Blue Cross and Blue Shield of Tennessee (BCBST) partners with MedSolutions for the management of outpatient, high-tech diagnostic imaging services. The prior authorization program began in August 2006 and initially applied only to Tennessee network providers.

The Advisory Committee on Immunization Practices (ACIP) recommendations for the upcoming flu season include five principal changes or updates.

In November 2007, the American College of Obstetricians and Gynecologists (ACOG) announced new recommendations emphasizing colonoscopy as the preferred method for cancer screening for both average-risk and high-risk women. The group changed its recommendation because colonoscopy allows for direct visualization of the entire colon surface, removal of any precancerous lesions and access to right-sided lesions – the main type of advanced colorectal cancer occurring in women.

Annual gynecological exams and regular mammography screenings are two of the most important women’s preventive health measures.

On Oct. 1, 2008, Caremark^® Specialty Pharmacy Services will become the preferred participating provider¹ for Blue Cross and Blue Shield of Florida (BCBSF) and Health Options members²* who are prescribed high-cost oral, injectable, infused or inhaled medications to treat chronic diseases. These medications include injectables that may be self-administered by the patient or drugs that may be infused by a health care provider, depending on prescribing guidelines.

Effective Oct. 1, 2008, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) and Health Options, Inc. will expand two components of our Responsible Rx pharmacy program for BlueCare, BlueChoice and BlueOptions members. Responsible Rx refers to an umbrella of programs including Responsible Quantity, Responsible Step and Responsible Dose programs.

Don’t speak Spanish? The ability to communicate with Latino patients is crucial in helping them to understand their conditions and treatment plans.