2015 All Payers Workshop Presented by Blue Cross and Blue Shield of - PowerPoint PPT Presentation

2015 All Payers Workshop Presented by Blue Cross and Blue Shield of Kansas December 11, 2015 An independent licensee of the Blue Cross Blue Shield Association

AGENDA  Story Time…..  Institutional Relations eNews  Telemedicine  Pre-determination and Prior Authorization  Benefits of filing electronically  Facility Information Change Form 2

Institutional Provider Relations eNews • Re-connect with us • January 1, 2016 • Sign up today! 29

Telemedicine • Physician specialty not available in the community • Primary care services not covered • HIPAA, state and federal compliant • Originating site - Bill Q3014 30

Predetermination and Prior Authorization Predetermination • Form available on the Web - http://www.bcbsks.com/CustomerService/Form s/pdf/15-7_predeterm_request_frm.pdf • 15 business days • Priority predetermination approximately 3 days • Letter will advise of decision • Check Benefits via Availity 31

Predetermination and Prior Authorization Prior Authorization • List available on the Web - http://www.bcbsks.com/CustomerService/Provid ers/MedicalReview/pre-cert_pre-auth.shtml • BRCA 1 and BRCA 2 Testing • Human Growth Hormone • IVIg/SCIg • Synagis 32

Benefits of filing electronically • Earlier payment • Earlier detection of errors • Lower cost 33

Facility Information Change Form • New form for institutional providers to report changes to their Provider File • New form can be found at: http://www.bcbsks.com/CustomerService/Forms/ pdf/15-218_FacilityProviderFileUpdate.pdf • Form can be completed electronically, but it will need to be printed and sent to BCBSKS by mail or fax. 34

Thank you for attending today! Questions? 35