NCMGMA BCBS Committee Report

Notes from the quarterly meeting with BCBSNC are provided below.    The main focus of this meeting was on the manual review of claims in the individual and small group business lines.  There is no timetable on complete resolution of the code in the system, but the issues are being worked from largest to smallest to resolve the greatest number of claims.  We will continue to advocate for our members if you are seeing claims or payment issues outside of this particular issue.

  1. Pulse8
    1. http://www.bcbsnc.com/content/providers/news-and-information/news/Pulse8_CareGap_Alerts.htm
    2. Partnered with BCBS on ACA commercial risk adjustment business
    3. From Blue E, select the Risk Adjustment tab
    4. BQPP webinars available
  2. Electronic Solutions and BLUE E
    1. Grace Period alert updated to more accurately identify ACA Exchange members receiving a premium subsidy who are delinquent in paying.  BLUE E will start showing the grace period alert again the week of 4/18.  You will likely receive a bulk package of grace period notifications in the short term due to the suspension of these notifications while BCBS worked out the member enrollment issues the first months of the year.
    2. Call Provider Blue Line if you see ALERT, but member saying they are paid up
    3. Claim Status – FACETS system only returns the most recently processed, finalized claims as opposed to previously adjudicated original claim and the corrected adjusted claim
    4. Enhancement on remittance inquiry search – put in a date and it will look back for last 7 days (coming end of May)
    5. April 15th Med Advantage and Med Supp paper EOPs will STOP
    6. Blue E Benefits section – we are advocating as a group for a more useful benefits section in Blue E including covered preventive services.  This is not a formal project at BCBS at this time, but it has been discussed at the past two meetings.
  3. Claims
    1. Individual / Small Groups Claims Review – they are fixing largest issues first and once fixed, sending those claims back through for processing.  Interest will be paid in accordance with the prompt pay statute.  60-120 days is the current processing timeframe for this group of claims. http://www.bcbsnc.com/content/providers/news-and-information/news/Secondary_Review_Claims_031116.htm
      1. Requested better notification in Blue E claim status on this particular issue – the status is not clear regarding the manual review of these claims.
    2. 12 month timely filing limit for corrected claims by DOS – BCBS is willing to address or review issues with timely filing should they arise as a result of the delay in processing on individual and small group claims
  4. FACETS system
    1. No additional business will be moved to this system in 2016
    2. Focusing on resolving current issues before moving forward with shifting additional business to the new platform
  5. Provider Line Customer Service
    1. Average wait time is now 10 minutes – significant improvement over the last three months.
    2. The “Request a Call Back” feature has been added back to the system effective 4/13/2016
    3. They still have staff on mandatory hours of overtime to accommodate volume
    4. Exploring options for online provider service communication
  6. Virtual ID cards – the committee advocated AGAINST these with BCBS and to our delight, they have discontinued internal discussions on the topic (at least for now)
  7. Networks and Strategy
    1. Considerations for future:  slightly shrinking the network, site of service incentives, performance based contracts, expanding bundled payment programs to include services other than total joint replacements.

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