Partners in Health Update - Februrary 2016 · Partners in Health UpdateSM is a publication of...

updateSM

Reminder: Common ICD coding errors identified on paper and electronic claims page 5

1500 Claims Submission and Claim Log transactions coming soon to NaviNet® page 7

February 2016

New preferred providers for Direct Ship Drug Program and IVIG/SCIG home infusion page 9

Models are used for illustrative purposes only. Some illustrations in this publication copyright 2016 www.dreamstime.com. All rights reserved.Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association.This is not a statement of benefits. Benefits may vary based on state requirements, Benefits Program (HMO, PPO, etc.), and/or employer groups. Providers should call Provider Services for the member’s applicable benefits information. Members should be instructed to call the Customer Service telephone number on their ID card.The third-party websites mentioned in this publication are maintained by organizations over which Independence exercises no control, and accordingly, Independence disclaims any responsibility for the content, the accuracy of the information, and/or quality of products or services provided by or advertised in these third-party sites. URLs are presented for informational purposes only. Certain services/treatments referred to in third-party sites may not be covered by all benefits plans. Members should refer to their benefits contract for complete details of the terms, limitations, and exclusions of their coverage.NaviNet is a registered trademark of NaviNet, Inc., an independent company.FutureScripts and FutureScripts Secure are independent companies that provide pharmacy benefits management services.CPT copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Partners in Health UpdateSM is a publication of Independence Blue Cross and its affiliates (Independence), created to provide valuable information to the Independence-participating provider community. This publication may include notice of changes or clarifications to administrative policies and procedures that are related to the covered services you provide in accordance with your participating professional provider, hospital, or ancillary provider/ancillary facility contract with Independence. This publication is the primary method for communicating such general changes. Suggestions are welcome.

Contact information:Provider CommunicationsIndependence Blue Cross1901 Market Street 27th FloorPhiladelphia, PA 19103

[email protected]

Inside this edition

► Articles designated with a blue arrow include notice of changes or clarifications to administrative policies and procedures.

For articles specific to your area of interest, look for the appropriate icon:

Professional Facility AncillaryKeystone Health Plan East, Personal Choice®, Keystone 65 HMO, and Personal Choice 65SM PPO have an accreditation status of Commendable from NCQA.

Administrative ► Member liability for missed appointments ► Update to Independence Administrators’ Health Utilization

Management program ● Update your provider information with us

Billing ● Reminder: Common ICD coding errors identified on paper and

electronic claims ► Upcoming changes to claims reporting requirements for home

infusion providers

NaviNet®

► 1500 Claim Submission and Claim Log transactions coming soon to NaviNet®

BlueCard®

► New address for sending Host Plan medical records

Medical ► View up-to-date policy activity on our Medical Policy Portal

● Reminder: Independence medical record requests and ePASS® submissions now using EFT for payments

► New preferred providers for Direct Ship Drug Program and IVIG/SCIG home infusion

► Telemedicine solutions for Independence commercial members

Pharmacy ► New guide available regarding high-risk medications

● Resources available to promote antimicrobial stewardship in our community

► Opioid abuse epidemic ● Reminder: Important message for providers who prescribe drugs

for Medicare patients

Health and Wellness ● Encourage pregnant Independence members to enroll in

Baby BluePrints®

● Heart disease vs. exercise — fight fire with fire

ADMINISTRATIVE

February 2016 | Partners in Health UpdateSM 3 www.ibx.com/providers

Member liability for missed appointments According to the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage plans, and their contracted providers, may charge members administrative fees for missed appointments under certain circumstances. However, if a provider charges for missed appointments, he or she must charge the same amount for all patients (i.e., Medicare or non-Medicare).

According to the Professional Provider Agreement for Independence-participating providers, although the provider may charge for a missed appointment, he or she may not charge a “surcharge,” such as an added fee — above and beyond their member liability — for services rendered. Such a practice creates a barrier to access to care and violates CMS anti-discrimination regulations.

The Provider Manual for Participating Professional Providers, which is available in the Current Publications section of Independence NaviNet® Plan Central, is being updated to reflect this position.

Update to Independence Administrators’ Health Utilization Management program Each year, the medical directors at Independence Administrators review the list of medical services and drugs that require precertification under Independence Administrators plan members’ medical plans. They consider provider practices, evidence-based medicine, current standards of care, technology changes, and utilization trends. On April 1, 2016, the updated list of services and medications that require precertification will take effect for Independence Administrators plans. This list will be available at www.ibxtpa.com/providers under “Procedures and medications that require precertification.”

Coordination of precertification requests Some of the services or supplies on the precertification list may not be covered by a particular Independence Administrators plan member’s medical benefits. When you request precertification, Independence Administrators applies the benefits as defined in the Independence Administrators plan member’s medical plan documents.

It is important that you request required precertification on your Independence Administrators plan member’s behalf. You can request precertification through Independence Administrators in one of the following ways:

● Submit the request electronically through iEXCHANGE® at www.ibxtpa.com/providers.

● Call the number on the Independence Administrators plan member’s ID card.

Independence Administrators will apply the specified benefit reduction as described in the medical plan if an Independence Administrators plan member receives a covered service or supply without the required precertification. Independence Administrators will not precertify or authorize items that the member’s plan does not cover. For precertification of behavioral health services, please contact Magellan HealthCare, Inc., an independent company, at the phone number on the plan member’s ID card.

How this may affect prescription drug benefits Independence Administrators uses this list solely to administer medical benefits. If an Independence Administrators plan member has a prescription drug program through FutureScripts®, an independent company, the drugs on the medical precertification list are not covered under their prescription plan. However, some medications on the Independence Administrators medical precertification list may be covered through other pharmacy benefit managers’ programs.

If you have questions about this update to Independence Administrators’ Health Utilization Management program or the updated precertification list, please contact Independence Administrators Provider Relations at [email protected].

Magellan Healthcare, Inc., an independent company, manages mental health and substance abuse benefits for most Independence members.

ADMINISTRATIVE


Update your provider information with usHave you made any changes to your key provider information? It is important that you notify us of any changes to the following:

● your mailing address ● your phone number ● your office hours ● name of your practice ● your acceptance of new patients ● your plan to dissolve your practice

We value your help in keeping our data files current. Accurate data files allow us to provide you with important information on billing, claims, changes or additions to policies, and announcements of administrative processes.

Professional providers Please contact your Network Coordinator and notify them of any changes to your information.

Facility and ancillary providers Per your contract, you are required to submit any changes to your information in writing. This request should be sent directly to the Senior Vice President of Contracting and the Legal Department at the addresses below:

Independence Blue Cross Attn: Senior Vice President, Provider Networks and Value-Based Solutions 1901 Market Street, 27th Floor Philadelphia, PA 19103

Independence Blue Cross Attn: Legal Department 1901 Market Street, 43rd Floor Philadelphia, PA 19103

Sixty days’ advance notice is required for processing.

Note: This information does not apply to providers contracted with Magellan Healthcare, Inc., an independent company. Please contact your Magellan Network Coordinator, if you have any questions.

BILLING


Reminder: Common ICD coding errors identified on paper and electronic claimsSince the ICD-10 compliance date on October 1, 2015, Independence has noticed a number of common ICD coding errors that are affecting claims processing. Please follow the tips below to ensure that your claims are coded correctly:

● Do not bill ICD-9 and ICD-10 codes on the same claim. Per guidelines from the Centers for Medicare & Medicaid Services (CMS), you cannot bill with both ICD-9 and ICD-10 codes on a single claim unless otherwise specified.

● Use the appropriate ICD code: − Outpatient claims. For dates of service on or before

September 30, 2015, you must bill with ICD-9 codes. For dates of service on or after October 1, 2015, you must bill with ICD-10 codes.

− Inpatient claims. For dates of discharge on or before September 30, 2015, you must bill with ICD-9 codes. For dates of discharge on or after October 1, 2015, you must bill with ICD-10 codes.

● DME and home infusion claims. Durable medical equipment (DME) and home infusion claims should be coded based on the “From” date or initial date of service. If the “From” date is on or before September 30, 2015, you must bill with ICD-9 codes. If the “From” date is on or after October 1, 2015, you must bill with ICD-10 codes.

● Use the appropriate diagnosis qualifier: − Paper claims. When billing with ICD-9 codes, you must

use the qualifier “9”. When billing with ICD-10 codes, you must use the qualifier “0” (CMS-1500, box 21; UB-04, field 66).

− Electronic claims. Please refer to the most recent version of the HIPAA-mandated 5010 ASC X12 Implementation Guides for the 837I and 837P transactions.

● Use valid codes. Whether you are billing with ICD-9 or ICD-10 codes, please ensure that the codes you are using are valid and appropriate.

For more information, visit our dedicated ICD-10 web page at www.ibx.com/icd10, which includes Frequently Asked Questions.

BILLING


Upcoming changes to claims reporting requirements for home infusion providers Effective March 1, 2016, Independence will adopt new claims reporting requirements for drugs obtained from in-network home infusion providers. The following information will be required when submitting drug claims for home infusion vendors that are not owned by a hospital or health system in the Independence provider network:

● NDC. The specific National Drug Code (NDC) that corresponds to the drug formulation administered to the member must be reported.

● HCPCS or CPT® codes. The specific Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) code for the drug must be reported. Exception: For drugs without a specific HCPCS or CPT code, report the J3490 or J3590 not otherwise classified (NOC) code, as appropriate.

● Units of drug administered. Drug units must be reported in multiples of the dosage unit specified in the HCPCS/CPT code narrative. Exception: For drugs without a specific HCPCS or CPT code, report the units in multiples of the drug units specified in the NDC.

Failure to include these components in a claim may result in delayed processing and reimbursement.

Note: Precertification requests submitted through the NaviNet® web portal will continue to follow the same submission process that is in effect today.

For more information The following claim payment policies are being updated to address these new billing requirements and provide specific claims examples:

● Commercial: #00.01.49b: Reporting Requirements for Drugs and Biologics ● Medicare Advantage: #MA00.024a: Reporting Requirements for Drugs and Biologics

View the Notifications for these policies by visiting our Medical Policy Portal at www.ibx.com/medpolicy. Select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage under Active Notifications.

We ask that you review these policies in their entirety and share them with your staff so they can become familiar with the new requirements prior to March 1, 2016.

Please note that this change only applies to home infusion vendors that are not owned by hospitals or health systems in the Independence provider network. Home infusion vendors owned by hospitals or health systems in the Independence provider network should continue to bill according to the terms of their contract.

NAVINET®


1500 Claim Submission and Claim Log transactions coming soon to NaviNet®

In the coming weeks, Independence will introduce the new 1500 Claim Submission and Claim Log transactions. The 1500 Claim Submission transaction will allow providers who submit CMS-1500 claim forms to submit those claims using the NaviNet web portal. Providers will then be able to review the status of these submitted claims through the Claim Log transaction.

Please note the following details about the new 1500 Claim Submission transaction:

● Claims submitted using this transaction must have a date of service on or after October 1, 2015.

● Providers will be able to use the 1500 Claim Submission transaction to submit Independence commercial and Medicare Advantage claims, as well as out-of-area Medicare Advantage PPO claims.

● Providers will not be able to use the 1500 Claim Submission transaction to submit claims with secondary and tertiary payers.

● This transaction will be available to providers seven days a week: Monday through Saturday from 5 a.m. to 10 p.m. and Sunday from 9 a.m. to 9 p.m.

For more informationWe will publish user guides for these new transactions in the NaviNet Resources section of our Provider News Center at www.ibx.com/pnc/navinet. Announcements will be made on Independence NaviNet Plan Central and on our Provider News Center once the new guides are available.

If you have questions, please call the eBusiness Hotline at 215-640-7410.

BLUECARD®

New address for sending Host Plan medical recordsThe address for sending Host Plan medical records to Independence has been updated. Effective immediately, please send all Host Plan medical records to:

Independence Blue CrossHost Medical Records Department1901 Market StreetPhiladelphia, PA 19103

As a reminder, when a Host Plan receives a request for medical records from a Home Plan, it is very important that the records be sent in a timely manner to ensure that the claim is processed in a timely way and the services rendered to the out-of-area member are covered appropriately. To expedite the handling for Host Plan medical record requests, be sure to include a copy of the request letter with the medical records and only send the medical records that have been requested. In addition, for the quickest processing, Host Plan medical records can also be faxed to 215-238-7915 or emailed to [email protected].

Note: Independence cannot forward unsolicited medical records to another plan. This information does not apply to appeals or medical records requested directly from a Home Plan.

MEDICAL


View up-to-date policy activity on our Medical Policy Portal Changes to Independence medical and claim payment policies for our commercial and Medicare Advantage Benefits Programs occur frequently in response to industry, medical, and regulatory changes. We encourage you to view the Site Activity section of our Medical Policy Portal in order to keep up to date with changes to our policies.

The Site Activity section is updated in real time as changes are made to the medical and claim payment policies. Topics include:

● Notifications ● New Policies ● Updated Policies ● Reissued Policies ● Coding Updates ● Archived Policies

For your convenience, the information provided in Site Activity can be printed to keep a copy on hand as a reference.

To access the Site Activity section, go to our Medical Policy Portal at www.ibx.com/medpolicy and select Accept and Go to Medical Policy Online. From here you can select Commercial or Medicare Advantage under Site Activity to view the monthly changes. To search for active policies, select either the Commercial or Medicare Advantage tab from the top of the page. You can also get to our Medical Policy Portal through the NaviNet® web portal by selecting the Reference Tools transaction, then Medical Policy.

News & AnnouncementsIn addition to the information posted in our Site Activity section, articles related to our website and medical and claim payment policies are periodically posted within the News & Announcements section. Simply select the appropriate link (Commercial, Medicare Advantage, or MAPPO Host) under the News & Announcements header on the Medical Policy Portal homepage to stay informed of the latest information.

Reminder: Independence medical record requests and ePASS® submissions now using EFT for payments Payments issued on or after November 1, 2015, for medical record requests and SOAP Progress Note submissions through ePASS, will be processed and distributed through electronic funds transfer (EFT). We will continue to send paper checks for those providers who are not EFT-enabled; however, we encourage all providers to sign up for EFT.

If you are interested in receiving payment via EFT, please follow the instructions in our EFT Attestation and Registration Guide, which is available in the NaviNet® Resources section of the Provider News Center at www.ibx.com/pnc/navinet. If you have any questions on the EFT registration process, contact the eBusiness hotline at 215-640-7410.

MEDICAL


New preferred providers for Direct Ship Drug Program and IVIG/SCIG home infusion Effective March 1, 2016, Independence will have new preferred providers for both our Direct Ship Drug Program and for intravenous and subcutaneous immunoglobulin (IVIG/SCIG) drugs provided in the home. These changes will not affect medical necessity criteria or coverage determinations for our members.

Direct Ship Drug Program Walgreens and PerformRx, independent companies, have been chosen as preferred providers for our Direct Ship Drug Program. All requests for direct ship drugs will be fulfilled by these providers, with the exception of Synagis®, which will continue to be fulfilled by ACRO Pharmaceutical Services, an independent company.

Providers who currently order drugs through the Direct Ship Drug Program will be contacted in the next few weeks to ensure there are no gaps in drug fulfillment.

For more information on ordering drugs through our Direct Ship Drug Program, go to www.ibx.com/directship.

Home infusion IVIG/SCIGOption Care, an independent company, has been selected as the preferred provider for IVIG/SCIG drugs given in the home. Members who receive IVIG/SCIG from home infusion vendors that are not owned by a hospital or health system in the Independence provider network will be transitioned to Option Care.

Independence recently sent letters to affected members notifying them of this change and detailing the transition plan of service. Option Care will also provide outreach to these members to answer questions and schedule appointments with an Option Care home infusion nurse. In addition, Option Care will contact affected providers to answer questions and obtain new prescriptions for our members prior to the March 1, 2016, transition date.

Providers should talk to their Independence members who currently receive IVIG/SCIG drugs to see if they have any questions or concerns.

Note: Members who currently receive IVIG/SCIG drugs through home infusion vendors that are owned by a hospital or health system in the Independence provider network will not be affected by this change.

MEDICAL


Telemedicine solutions for Independence commercial members As part of Independence’s commitment to providing superior access to care, we are introducing a new telemedicine strategy for 2016. As the modern digital revolution continues, Independence is creating the opportunity for convenient, effective, and affordable health care solutions via digitized channels and virtual experiences. We are committed to expanding access to primary care, while addressing the diverse needs of our members, ensuring they receive quality health care services at affordable prices.

In the spectrum of care available to members, Independence considers telemedicine to be an option that enhances access for members, as does our network of retail health clinics and urgent care centers. Therefore, Independence is offering various telemedicine options for members when they otherwise may not be able to see a provider in person. It is important to note that the telemedicine solutions described below are not intended to replace the member’s relationship with their primary care provider. For emergencies, members should continue to be directed to the nearest emergency room/department (ER).

Outlined below is Independence’s approach to telemedicine for our commercial members.

Telemedicine for primary careAs introduced in the December 2015 edition of Partners in Health Update, Independence now covers telemedicine encounters for our commercial members seeking primary care services from primary care providers (family medicine, internal medicine, general medicine and pediatric medicine) who offer telemedicine services as an additional method of delivery. These encounters allow our members to interact with primary care providers using a HIPAA-secure audio/visual system that allows members and providers to see and hear one another in real time. For specific coverage information, please review Claim Payment Policy #00.10.41: Telemedicine for Primary Care Services, which is available on our Medical Policy Portal at www.ibx.com/medpolicy. Select Accept and Go to Medical Policy Online, and then the Commercial tab from the top of the page. Type the policy name or number in the Search field.

Benefits include: ● Gives primary care providers the ability to communicate with their patients in the event that an in-person

encounter is not possible. ● Provides a more cost-effective option than visiting an ER, retail health clinic, or urgent care center for

non-emergency medical conditions. ● Offers care after normal business hours, including nights, weekends, and even holidays (availability may vary).

continued on the next page

MEDICAL


National vendor telemedicine solutionIndependence has contracted with MDLIVE®, a national vendor that connects individuals to board-certified primary care physicians via HIPAA-secure video, telephone, or mobile app 24/7/365. These physicians can diagnose medical conditions, provide short-term treatment plans, and may prescribe medications for non-emergency medical conditions. The member can get information on physician profiles, check appointment availability, and schedule an appointment with the physician of their choice. The member may request a copy of the medical records from these telemedicine encounters to share with their primary care provider. Note: This program is available only to certain commercial members depending upon their plan benefits and employer group. Members should check their benefits handbook to verify eligibility for this service.

Benefits include: ● Provides alternate care options for non-emergency medical conditions when it’s not possible to visit an ER,

retail health clinic, or urgent care center. ● Allows members to access non-emergency medical care while traveling*.

*Due to state regulations, telemedicine services are not available in the state of Arkansas.

JeffConnect This Pilot Program is currently available to Independence employees and their dependents, and allows members to connect with emergency medicine physicians from Jefferson University Physicians, Jefferson Medical Care, or Methodist Associates in Healthcare (Jefferson) 24/7/365 via a HIPPA-secure video conference on a smartphone, tablet, or camera-equipped computer.

Proper utilizationTelemedicine improves access to care but does not always replace an in-person visit with a physician. Here are some examples of when it’s appropriate to utilize telemedicine:

● As an alternative for the ER, retail health clinic, or urgent care center for a non-emergency medical issue. Some ideal situations for utilizing telemedicine include: allergies, asthma, colds, ear infections, rashes, insect bites, sinus infections, sore throats, and urinary tract infections.

● To request a prescription, when appropriate. Members utilizing telemedicine can obtain prescriptions for non-narcotic medications (not controlled substances) that in most cases can be sent directly to the pharmacy of their choice.

● When it is not convenient to leave home or work.

As telemedicine continues to evolve and expand and as the technology improves, Independence will keep you up to date with relevant changes to our policies and benefits. If you have any questions, please contact your Network Coordinator.

continued from the previous page

PHARMACY


New guide available regarding high-risk medications Through Partners in Health Update, we have been providing you with information about high-risk medications (HRM) and the increased potential for side effects in adults ages 65 and older. In this edition, we want to advise you of a new reference tool that can be used when prescribing HRMs.

Initially derived from the American Geriatric Society’s “Beer’s Criteria,” HRMs have been proven to put older patients at a higher risk for adverse drug events. There is an even greater risk when a patient is on more than one medication considered an HRM.

Quick reference guideIndependence has recently created the 2016 High-Risk Medication Quick Reference Guide. This guide, which is for informational purposes only, includes select HRMs that are routinely prescribed for individuals ages 65 and older and lists potential alternatives for providers to consider in place of the HRM (when considered medically necessary) for the management of common conditions.

The guide is available on the NaviNet® web portal in the Administrative Tools & Resources section under Pharmacy Resources. You may also order a hard copy by submitting an online request at www.ibx.com/providersupplyline or by calling the Provider Supply Line at 1-800-858-4728.

Resources available to promote antimicrobial stewardship in our communityThe Infectious Diseases Society of America (IDSA) defines antimicrobial stewardship as “coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.”1 In the January 2016 edition of Partners in Health Update, we provided tips on how you can help to promote antimicrobial stewardship. With the cold and flu season upon us, we suggest that you review the campaign materials offered by the World Health Organization regarding proper antibiotic use and consider displaying them in your office. You can view and download the materials on their website at www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/en/.To learn more about antimicrobial stewardship in human medicine, visit the IDSA’s website at www.idsociety.org/Stewardship_Policy.

1 www.idsociety.org/Stewardship_Policy

www.idsociety.org/Stewardship_Policy

www.idsociety.org/Stewardship_Policy

PHARMACY


Opioid abuse epidemicMany physicians are concerned about the current epidemic of dependence, abuse, and deaths that have occurred over the past two decades with the concomitant rapid increase in opioid prescriptions. The United States now ranks number two in the world for opioid use per capita.1,2 A recent study in JAMA Internal Medicine showed that in veterans with chronic non-cancer pain, use of long-acting opioids was associated with unintentional overdose events compared with short-acting opioids, especially in the first 14 days of use.

In a statement published on Friday, December 18, 2015, the Centers for Disease Control and Prevention (CDC) provided the following statistics:

● U.S. deaths from drug overdoses hit a record high in 2014, propelled by abuse of prescription painkillers and heroin.

● Drug overdoses increased 6.5 percent in 2014 from a year earlier, killing 47,055 people.

● Deaths from opioids such as prescription pain killers and heroin accounted for 61 percent of overdose deaths and increased 14 percent in 2014.

● Deaths from prescription painkillers have been increasing for 15 years and there has been a recent surge in heroin-related deaths, tripling in the last four years.

● Lower heroin prices, wider availability, and higher purity are causing more overdoses.

In addition, because of the lack of high-quality randomized trials, some experts feel that starting opioid therapy in chronic non-cancer pain with long-acting agents should be completely avoided. Current evidence also supports avoiding long-acting agents altogether, not co-prescribing other sedating drugs, keeping morphine-equivalent doses <80 mg per day, and maintaining strict control of quantity and interval of dispenses and protocols to taper or stop opioids.3

The CDC recommends stricter guidelines for prescribing pain killers, including the expanded availability of and wider access to naloxone, an antidote for opioid-related overdoses.

Please be aware of these statistics and the CDC’s recommendations when prescribing opioids to your patients. To read the CDC’s press release in its entirety, visit www.cdc.gov/media/releases/2015/p1218-drug-overdose.html.

1 Dhalla IA et al. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ. 2009;181:891-6

2 Bohnert AS et al. Association between opioid prescribing patterns and opioid overdose-related deaths JAMA. 2011:305:1315-21

3 Chou R et al. The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015:162:276-86

Reminder: Important message for providers who prescribe drugs for Medicare patientsBeginning June 1, 2016, the Centers for Medicare & Medicaid Services will enforce a requirement that Medicare Part D prescription drug benefit plans may not cover drugs prescribed by providers who are not enrolled in (or validly opted out of) Medicare, except in very limited circumstances. Therefore, for providers not currently enrolled in Medicare, unless you enroll (or validly opt out), Medicare Part D plans will be required to notify your Medicare patients that you are not able to prescribe covered Part D drugs. Please note that if you opt out, you cannot receive reimbursement from traditional Medicare or a Medicare Advantage plan, either directly or indirectly (except for emergency and urgent care services).

If you need assistance with the process of enrolling in (or validly opting out of) Medicare, please contact the Medicare Administrative Contractor within your geographic area.

www.cdc.gov/media/releases/2015/p1218-drug-overdose.html

www.cdc.gov/media/releases/2015/p1218-drug-overdose.html

HEALTH AND WELLNESS


Encourage pregnant Independence members to enroll in Baby BluePrints® The Baby BluePrints program supports expectant mothers and promotes a healthy pregnancy throughout each trimester. We ask that you inform pregnant Independence members about the Baby BluePrints program at their first prenatal visit and encourage them to self-enroll by calling our toll-free number, 1-800-598-BABY. Upon calling, a Health Coach will explain the program to the member and ask her a series of questions to complete the enrollment process.

Once enrolled in the program, members will receive a welcome letter that includes information on how to access educational materials on our secure member website, www.ibxpress.com, and the 1-800-598-BABY phone number for questions and support during pregnancy. In addition, high-risk members eligible for condition management will be given the name and contact information for a Health Coach.

Resources available Upon request, a flyer is available to place in the member’s chart and distribute at the first prenatal visit to encourage her to enroll in Baby BluePrints. To order flyers, please submit an online request at www.ibx.com/providersupplyline or call the Provider Supply Line at 1-800-858-4728. If you have any questions, please call Customer Service at 1-800-ASK-BLUE.

Postpartum office visitsAs a reminder, postpartum visits should be scheduled 21 to 56 days after delivery. Adhering to this time frame provides the best opportunity to assess the physical healing for new mothers and to prescribe contraception, if necessary. These visits should be scheduled before members are discharged from the hospital.

HEALTH AND WELLNESS


Heart disease vs. exercise — fight fire with fireHeart disease kills approximately 600,000 Americans every year, making it the leading cause of death in the United States. High cholesterol, high blood pressure, and smoking are three key risk factors for heart disease, and 49 percent of Americans have at least one of those three risk factors.1 Those statistics make it highly likely that every doctor has older patients who either have or are at risk for developing heart disease. Medication is sometimes the necessary approach, but other medical conditions and lifestyle choices that increase risk — obesity, diabetes, physical inactivity, poor diet, and excessive alcohol use — can be controlled by leading an active, healthy lifestyle.

The facts are convincing, but getting older adults to adopt new habits often takes a lot more than statistics and a recommendation. That’s why Healthways SilverSneakers® Fitness program is offered at no additional cost to Keystone 65 Select HMO, Keystone 65 Preferred HMO, Keystone 65 Focus Rx HMO, and Personal Choice 65SM PPO members. SilverSneakers provides an actionable program to help members develop health and fitness goals, as well as a strong support system to help achieve them. With millions of members, SilverSneakers is the nation’s leading fitness program exclusively for older adults.

The SilverSneakers membership includes: ● fitness membership with access to more than 13,000 locations nationwide; ● indoor and outdoor fitness classes designed specifically for older adults; ● a members-only website and online community; ● a strong social network and support system.

Heart muscles get stronger and healthier with exercise, and the more exercise, the lower the risk of heart disease.2 That means heart disease isn’t inevitable — exercise can change the statistics. It’s time to fight fire with fire. Encourage your Independence Medicare Advantage patients to learn more about the program, find the closest SilverSneakers location, or get their ID number by visiting silversneakers.com or calling 1-888-423-4632 (TTY: 711).

1www.cdc.gov/heartdisease/facts.htm2www.nlm.nih.gov/medlineplus/ency/article/004006.htm

SilverSneakers is a registered mark of Healthways, Inc., an independent company.

www.cdc.gov/heartdisease/facts.htm

www.nlm.nih.gov/medlineplus/ency/article/004006.htm

www.silversneakers.com

Visit our Provider News Center: www.ibx.com/pnc

*Outside 215 area code

Important Resources

Anti-Fraud and Corporate Compliance

Hotline 1-866-282-2707 or www.ibx.com/antifraud

Care Management and Coordination

Baby BluePrints® 215-241-2198 / 1-800-598-BABY (2229)*

Case and Condition Management 1-800-313-8628

Credentialing

Credentialing Violation Hotline 215-988-1413 or www.ibx.com/credentials

Customer Service

Provider Services 1-800-ASK-BLUE (1-800-275-2583)

Provider Automated System User Guide www.ibx.com/providerautomatedsystem

Electronic Data Interchange (EDI)

Highmark EDI Operations 1-800-992-0246

FutureScripts® (commercial pharmacy benefits)

Prescription drug prior authorization 1-888-678-7012

Pharmacy website (formulary updates, prior authorization) www.ibx.com/rx

FutureScripts® Secure (Medicare Part D pharmacy benefits)

FutureScripts Secure Customer Service 1-888-678-7015

Formulary updates www.ibxmedicare.com

NaviNet® web portal

Independence eBusiness Hotline 215-640-7410

Registration www.navinet.net

Other frequently used phone numbers and websites

Independence Direct Ship Drug Program (medical benefits) www.ibx.com/directship

Medical Policy www.ibx.com/medpolicy

Provider Supply Line 1-800-858-4728 or www.ibx.com/providersupplyline

Partners in Health Update - Februrary 2016 · Partners in Health UpdateSM is a publication of...

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Transcript of Partners in Health Update - Februrary 2016 · Partners in Health UpdateSM is a publication of...