BCBS Committee Update: December 2015

The following are notes from the most recent meeting with BCBSNC.  If you have specific questions or concerns, please contact a BCBS committee representative to assist you.

Narrow Networks

Narrow network product Blue Value was first introduced in 2013.  Last year, we saw a narrow network, Blue Local, added in the Charlotte market and in 2016 we will see Blue Local in the Triangle market.  These plans are here to stay for now and practices cannot “apply” for participation in these narrow network products, but please see the letter below from our NCMGMA President regarding advocacy surrounding these types of plans:

Good Morning Fellow NCMGMA Members,

I wanted to write to you briefly and let everyone know that NCMGMA, the BCBS Committee, the NC Medical Society and the Advocacy Task Force are heavily involved in these issues and will continue to both monitor the changes in addition to having a seat at the table with the stakeholders surrounding these networks.  As with many issues, much of the work goes on behind the scenes and I can assure you these issues are not taken lightly.  Our committees and task forces are hard at work. 

We posted a great article from Modern Healthcare on the blog yesterday regarding this very topic, I highly recommend the read.  https://ncmgm.wordpress.com/2015/12/01/cms-looks-to-imposing-minimum-standards-to-narrow-provider-networks

Please do not hesitate to reach out to myself, Melissa White (BCBS Chair) or Cameron Cox (Advocacy Chair) with any specific issues.  We are  here to help! 


Jacob A. Rodman
2015-2016 NCMGMA President

TouchCare – Telemedicine

The BCBS investment arm along with Medical Mutual and Fortress Investments are investing in Durham based TouchCare, a telemedicine company.  TouchCare was created in 2013 and aims to connect patients to THEIR healthcare providers in the mobile space.  Practices are using it to provide better access, increase compliance with follow up visits, and to aid in provider to provider calls.

BCBS Telehealth policy:

Medical Records

Proactive submission of medical records to support medical necessity is now available as of December 1st.  Please refer to the following link for the services typically requiring medical records and the protocols for submission of proactive records.

Electronic Solutions

Blue Medicare Advantage and Blue Supplement are now merged with Blue E.  You no longer need to use HealthTrio for these lines of business.

Credentialing / Contracting

  • Rolled out a new provider information management system.
  • Working on a bulk upload enhancement for mass enrollment, terminations and updates.

State Health Plan Overpayments

Affected practices will receive a bar coded invoice containing the overpayments.  You may return a check or choose to have voucher deductions.

EFT Requirement

If you are not currently enrolled for EFT payments, please do so before the end of February 2016.

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