August Lunch & Learn Webinar Recording

Strengthening the Provider-Payer Partnership from Onboarding to the Point of Care

Thank you to everyone who participated in our Lunch & Learn Webinar on August 16th. BCBSNC discussed how they are reimagining its partnership with the provider community through multiple initiatives that redesign the onboarding process to improve the provider experience and “meet care teams where they are” with actionable data, technology tools, and hands-on support to impact care outcomes. At the button below, you will find a link to the webinar video recording.

August 16th Webinar Recording

Follow this link to view the transcript of the webinar’s Q&A session.

Thank you again for participating. Watch your email and the website for more webinars coming soon.

Blue Cross Blue Shield of North Carolina Product Changes and FYIs

The NCMGMA BCBS Committee would like to draw your attention to recent changes, and likely more change in the future, to certain BCBS products. The links noted will provide more detail and the committee suggests you keep a close watch on http://www.bcbsnc.com.

State Health Plan Changes

• North Carolina State Health Plan Board of Trustees voted to end the provider designation program at the end of 2018
  • Between 10/1/18 and 12/31/18, SHP members will no longer see two designations: one for the current year and one for the next year on the Provider Directory, they will only see the current year’s designation.
  • Effective 1/1/19, there will not be any Provider Specialty or Facility Designations on the Provider Directory

   

• More information should come out this Fall regarding potential plan changes. To stay informed, check The Board of Trustees meeting materials page for full details: https://www.shpnc.org/about-us/board-trustees-meeting-materials
• Blue Cross and Blue Shield will send out notifications regarding any fee schedule, reimbursement, or contract changes per the State’s requirements after the Board approves any changes to the plan

Blue Local Changes

• Triangle market – Blue Local product eliminated for 2019. Members will be moved to Blue Value unless they opt for a different plan
• Charlotte market – a Blue Local product remains for 2019

Blue Value Changes

• Triangle market – UNC Health Alliance will be the exclusive in-network provider for Blue Cross ACA (Blue Value) plans in the Triangle in 2019

Question: What if my practice is in network for Blue Value, but NOT for UNC Health Alliance?

Answer from BCBS: We are not removing any providers from Blue Value in the Triangle. For 2019, Blue Value non-UNC Health Alliance providers can continue to see ACA members in the Triangle. Providers can always check their participation status by reviewing their current BCBSNC participation agreements or calling their local Provider Relations consultant.

https://www.bluecrossnc.com/sites/default/files/document/attachment/providers/public/pdfs/news-and-information/news/2019%20ACA%20Rate%20Release_FINAL.pdf

UNC Health Alliance: https://www.unchealthcare.org/health-alliance/for-providers/

As the NCMGMA BCBS Committee is made aware of changes we will keep you informed.

Greensboro Multi-Payer Provider Expo on August 16th

Greensboro Multi-Payer Provider Expo

August 16, 2018
Sheraton Greensboro Four Seasons
3121 W. Gate City Blvd.
Greensboro, NC 27407

Mark your calendars and make plans to attend the Greensboro Multi-Payer Provider Expo sponsored by Blue Cross Blue Shield of North Carolina, United Healthcare and MedCost.

Schedule of Events

8:00 AM – 1:00 PM — Exhibit Hall Open
9:00 AM – 10:00 AM — Helping Providers Succeed in Value Based Care
10:00 AM – 11:00 AM — Design Thinking and the Millennial Patient

Registration

Follow this link for a printable registration form. Please fax completed registration form to (855) 754-3681 by Friday, August 10, 2018.

BCBSNC Updates: March 7, 2016

The following are the most recent updates and important notices from BCBSNC:

Release Dates: March 7-8, 2016

• Provider Call Center Resumes Full Service
• Routine Chiropractic Services Not Covered Under Blue Medicare Benefits
• Medicare Advantage Providers: Please Review Your Demographic Information With BCBSNC

Important Updates and Reminders:  

• Rx Utilization Management Changes Effective April 1, 2016
• Have you signed up for our convenient EFT service?  Electronic funds transfer (EFT) will become BCBSNC’s standard provider payment method, so sign up today!

Did you know these articles are posted online on the Important News page of our provider Web portal at www.bcbsnc.com/providers?  Please visit the news page and scan through recent and past articles at your convenience.

Have you signed up to receive news and updates from BCBSNC via Provider eBriefs, our e-news service?  If you are not registered, please sign up to begin receiving these timely and important e-communications today.

Multi-Payer Provider Expo on April 5th

Tuesday, April 5, 2016
8:00 AM – 1:00 PM
Marriott at Research Triangle Park
4700 Guardian Dr.
Durham, NC 27703

Blue Cross Blue Shield of North Carolina, Humana, MedCost, and United Healthcare have partnered together to offer a FREE event. Don’t miss this opportunity to speak one-on-one with expert representatives from each payer, along with other guest exhibitors. Visit each payer and guest to have your name entered into a door prize drawing. Refreshments provided.

Guest Speaker Susan Richards of Humana will present “Improving Clinical Documentation and Why It Matters.”  This course is eligible for 2.0 CEU credits.  The session will be offered at two different times: 9:00 AM – 10:00 AM (breakfast provided) and 11:00 AM – 12:00 PM (lunch provided).  The exhibit hall will be open from 8:00 AM – 1:00 PM.

For more information and a printable registration form, follow this link.  Registration closes Wednesday, March 30th.

BCBSNC Updates: January 28, 2016

The following are the most recent updates and important reminders from BCBSNC:

Release Dates: January 28, 2016

• Provider Blue Line Open Saturday, January 30, From 9 a.m. to 1 p.m.
• A New Way of Managing Orthopedic Services for BCBSNC Medicare Advantage Members

Important Reminders:  

• BCBSNC’s Contract with Carteret Health Care in Morehead City will end February 1, 2016, for our commercial products, including the State Health Plan and the Federal Employee Program.
• Please Note: We continue to experience higher than normal call volumes.  At this time, we are asking providers to limit calls to member eligibility, benefits or authorization questions for services scheduled in January or early February only.  Please use Blue e^SM for claim status inquiries.  We are working to resume full service as soon as possible.

Did you know these articles are posted online on the Important News page of our provider Web portal at www.bcbsnc.com/providers?  Please visit the news page and scan through recent and past articles at your convenience.

Have you signed up to receive news and updates from BCBSNC via Provider eBriefs, our e-news service?  If you are not registered, please sign up to begin receiving these timely and important e-communications today.

BCBSNC Updates: January 25, 2016

Blue Cross and Blue Shield of North Carolina (BCBSNC) is committed to informing health care providers and facilities participating in our networks about recent medical policy updates, new products and programs, and other relevant BCBSNC news.

The following links are to articles of interest published on BCBSNC’s provider-specific Important News page . Please share this e-newsletter with others in your office who may benefit from the information and encourage them to sign up to receive it directly.

Release Dates: January 19-22, 2016

• Additional Methods Available for Managing Patient Care Needs
• Be Sure to Include the Entire Member ID Number on Claims

Important Reminders

• What to Do If Your BCBSNC Patient Has Not Yet Received a 2016 ID Card
• Please review the article posted in December about the changes you will now see on ID cards issued to our individual and small group members enrolled on our new technology platform.
• Have you signed up for our convenient EFT service?  Please note that electronic funds transfer (EFT) will become BCBSNC’s standard provider payment method as of March 1, 2016. Sign up today!
• BCBSNC’s contract with Carteret Health Care in Morehead City will end February 1, 2016, for our commercial products, including State Health Plan and the Federal Employee Program.

BCBSNC Provider eBriefs: Week of January 8, 2016

January 8, 2016

Blue Cross and Blue Shield of North Carolina (BCBSNC) is committed to informing health care providers and facilities participating in our networks about recent medical policy updates, new products and programs, and other relevant BCBSNC news.

The following links are to articles of interest published on BCBSNC’s provider-specific Important News page . Please share this e-newsletter with others in your office who may benefit from the information and encourage them to sign up to receive it directly.

Release Dates: December 22, 2015 – January 5, 2016

Please note that our provider services call center has closed early today, in order what we may better assist our members due to higher than usual call volumes.  Please use Blue e^SM for eligibility, benefits, and claim status inquiries.

• 2016 Enrollment Delay Impacts Small Percentage of Individual Members
• CMS Announcement About Provider ECP Petition Process
• Medicare Advantage EFT Standard Payment Method as of March 1, 2016
• Rx Utilization Management Change Effective February 1, 2016 (also see article posted December 15, 2015)
• Part D Prescribers Must Enroll (or Opt-Out of) Medicare
• Information About Opiod Abuse Epidemic
• Federal Employee Program: Residential Treatment Center Benefit Changes for 2016

Important Reminders:

• Reminder that BCBSNC individual and small group members are now on our new technology platform as of January 1, 2016.  Read this article posted in late 2015 for more details about what you and your office staff need to know.
• Have you signed up for our convenient EFT service?  Please note that electronic funds transfer (EFT) will become BCBSNC’s standard method of provider payment as of March 1, 2016.  Sign up today!
• BCBSNC’s contract with Carteret Health Care in Morehead City to end February 1, 2016.

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! 

Respectfully,

Jacob A. Rodman
2015-2016 NCMGMA President
jrodman@raleighneurosurgical.com

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.

• http://www.touchcare.com/

BCBS Telehealth policy:

• http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/telehealth.pdf

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.

• http://www.bcbsnc.com/content/providers/news-and-information/news/Medical_Records_Process_Change_FINAL.htm

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.

• https://www.bcbsnc.com/content/providers/news-and-information/news/SHP_Duplicate_Payments_UPDATE.htm

EFT Requirement

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

• https://www.bcbsnc.com/assets/providers/public/pdfs/eftrequest-form.pdf

BCBSNC Updates: December 4, 2015

The following are the latest updates and important notices from BCBSNC:

Release Dates: November 20 through December 1, 2015

• Beginning December 1, Medical Records Can Be Submitted Upfront to Support Medical Necessity
• One Fax Number for All Blue Medicare Part D Rx Coverage Requests
• Pharmacy Benefit Changes Effective January 1, 2016
• Update Regarding State Health Plan Duplicate Claim Payments

Important Reminders:   

• Blue Medicare Providers:  Reminder to Include All Required Information on Claims (claims will deny and not be viewable on Blue eSM until required info is received.)
• New Response Time for Emergency Inpatient Admission Authorizations Effective December 1, 2015
• Have you signed up for our convenient EFT service?  Please note that electronic funds transfer (EFT) will become BCBSNC’s standard provider payment method as of March 1, 2016.  Sign up today!
• BCBSNC’s Contract with Carteret Health Care in Morehead City to end February 1, 2016.

Did you know these articles are posted online on the Important News page of our provider Web portal at www.bcbsnc.com/providers?  Please visit the news page and scan through recent and past articles at your convenience.

Have you signed up to receive news and updates from BCBSNC via Provider eBriefs, our e-news service?  If you are not registered, please sign up to begin receiving these timely and important e-communications today.