BCBS Committee Notes

By Lauren Ballew, BCBS Committee Chair

The following items were discussed at the fourth quarter BCBS Committee meeting:

  1. Medicare Stars Program
    1. CAHPS surveys sent to 3,000 Blue Medicare members between February and May
    2. Surveys are a large part of the star rating that the plan receives from CMS
  2. Quality Programs
    1. BCBS has 11 Quality Management Consultants (QCM) throughout the state to assist practices with BCBSNC Provider Quality Reports
    2. QCMs are available to meet with practices to provide tools and resources for improving quality scores and closing care gaps
    3. Quality.Management@BCBSNC.com to reach the team for assistance
  3. New Mobile App – rollout in Q1 2017
    1. The app is for members and will resemble the same content available in the current Blue Connect portal.
    2. Team is in research phase on a Provider App as well
  4. Claims / Customer Service Update
    1. No new business moving to the Facets platform (platform only in use for ACA plans)
    2. Medical review and appeals backlog created in 2016 due to Facets system issues have been cleared
    3. Customer staffing levels ramped for 2017 open enrollment
    4. Aetna and UHC ACA members impacted by their respective exits from the market are being routed to a specialized team at BCBS when calling regarding plan options
    5. Our committee is continuing to push for a “contact us” form or chat for provider inquiries. This is a top priority for Blue Cross as well.
    6. Resolution of claims issues – if you or your staff have issues getting particular claims resolved, please try the following:
      1. Contact customer service first – ALWAYS get a reference number for the call
      2. If claim still not resolved after 30 days, call customer service again and ask for the case to be escalated to a Team Lead – these floor leads should then coordinate directly with the claims team
      3. If your issue persists beyond that, I’m happy to get involved – please send the reference numbers to me and I will ask the Provider Service Manager to escalate the account
  5. eSolutions
    1. Updates to Blue E have been put on hold until the end of 2017
    2. EFT requirement for all providers went into effect on 11/30/2016
    3. Updates will be made to 835 remits in January and 837 claims in April 2017
  6. Benefit changes coming:
    1. Bariatric surgery – member will have requirement for 12 months of medical management prior to surgery once benefit change implemented

If you have any questions or general topics you would like the committee to address at our next meeting, please contact me directly at L.Ballew@msochealth.com. The committee would also like to recommend that practices review their status in the various BCSBSNC plans for 2017 to ensure changes do not impact you or your patients. Also, you may wish to review the available exchange products in your area in order to advise those Aetna and UHC ACA members who are shopping for new plans on the Exchange for 2017.

Happy Holidays,
Lauren Ballew

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